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THE  ROAD  TO  A  HEALTHY 
OLD  AGE 


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THE    ROAD  TO  A 
HEALTHY  OLD  AGE 


BY 
T.  BODLEY    SCOTT 

M.R.C.S.  eng.,  L.R.C.P.  Ed. 


NEW  YORK 

HENRY  HOLT  AND  COMPANY 
1919 


PREFACE 

A  FEW  years  ago  Messrs.  H.  K.  Lewis  and  Co. 
were  kind  enough  to  publish  for  me  a  small  book 
called  "  The  Road  to  a  Healthy  Old  Age."  This 
has  been  so  kindly  received  and  reviewed  that  I 
have  had  the  temerity  to  write  a  larger  book  on 
much  the  same  subject,  and  to  launch  out  still  fur- 
ther on  to  the  troubled  seas  of  morals  and  medicine. 
These  two  should  ever  go  hand  in  hand,  for  if  their 
paths  diverge,  we  soon  go  wrong,  and  our  footsteps 
slide ;  but  if  they  march  forward  together  with  the 
same  goal  in  view,  they  should  go  far  in  the  great 
fight  to  make  the  crooked  straight  and  the  rough 
places  plain. 

It  may  seem  presumptuous  to  try  to  follow  in  the 
steps  of  great  men  like  Sir  Hermann  Weber  and 
others  who  have  made  this  subject  their  special 
study,  but  during  the  last  few  years  the  physiol- 
ogical discoveries  of  the  properties  of  the  internal 
glands,  and  greater  knowledge  of  biological  chem- 
istry, have  enabled  us  to  do  much  more  for  the 
prevention  and  cure  of  many  of  the  morbid  con- 


VI  PREFACE 

ditions  of  advancing  years,  and  this  must  be  my 
excuse. 

Though  this  book  is,  perhaps,  chiefly  written  for 
my  medical  brethren,  I  have  tried  to  write  it  so 
that  any  thoughtful  reader  may  grasp  and  under- 
stand the  greater  part  of  the  argument.  Whatever 
the  verdict  may  be,  I  can  only  plead  King  David's 
old  excuse,  "  Eructavit  cor  meum  verbum  bonum  " 
(Ps.  xlv.),  and  I  humbly  hope  that  the  good  word 
may  here  and  there  fall  on  good  ground  and  bear 
some  fruit. 

We  talk  and  write  much  about  the  management 
and  welfare  of  children,  and  this  most  rightly,  and 
we  have  good  specialists  in  their  diseases,  but  there 
are  two  ends  to  life.  Middle  life  is  supposed  to  be 
able  to  look  after  itself,  which  it  does  with  no  very 
striking  success;  but  surely  old  age  is  much  neg- 
lected. We  have  no  committees  of  kindly  philan- 
thropic ladies,  with  their  infallible  knowledge  and 
wisdom,  to  look  after  us  and  to  guide  our  steps; 
and  we  have,  fortunately  perhaps,  no  specialist ;  and 
yet  what  a  field  for  pity  and  for  help!  The  vis 
medicatrix  naturce  has  lost  much  of  its  efficient 
conservative  power,  and  old  age  lies  almost  help- 
less, exposed  to  the  rough  and  chilly  winds  of  life; 
thus  old  age  becomes  too  often  a  tragedy,  and  one 


PREFACE  vii 

that  IS  mostly  unnecessary.  In  this  small  book  I 
hope  to  show  some  of  the  causes  of  the  evil  and  to 
point  out  the  means  of  prevention. 

One  constantly  hears  this  remark,  "  Poor  old 
So-and-so !  "  It  is  just  a  case  of  "  Anno  Domini/' 
and  the  callous  Levite  passes  by  on  the  other  side. 
The  good  Samaritan,  however,  and  the  good  phy- 
sician, the  complement  of  each  other,  pause,  and, 
figuratively  speaking,  pour  in  oil  and  wine,  and  so 
prolong  the  life  and  spirit  that  came  from  God. 

The  deplorable  wastage  of  health,  of  happiness, 
and  of  time,  that  goes  on  all  through  life,  but  es- 
pecially, perhaps,  in  old  age,  makes  a  sad  contempla- 
tion. We  are  taught  to  look  for  a  new  heaven  and 
a  new  earth,  but  we  take  the  teaching  of  the  Bible 
far  too  literally,  and  often  miss  the  real  lesson.  We 
know,  and  can  know,  nothing  of  the  new  heaven, 
but  we  can  all  gird  up  our  loins  and  help  to  make 
a  new  earth  here  and  now,  and  everyone  who  can 
add  to  the  happiness,  the  efficiency,  and  the  length 
of  life  of  man  is  helping  on  that  great  cause. 

The  treatment  of  disease  in  the  past,  and  often 
now,  is  made  too  much  of  a  mystery.  The  busi- 
ness of  the  medicine-man,  in  semi-savage  tribes,  is 
a  gigantic  bluff  to  conceal  his  ignorance.  Are  we, 
as  a  profession,  entirely  innocent  of  this  bluff?    To 


via  PREFACE 

get  the  results  we  want,  among  those  who  have 
come  to  years  of  discretion,  we  must  be  perfectly 
honest,  for  without  their  confidence  and  co-opera- 
tion we  shall  fail.  To  the  scientific  mind  of  to-day, 
the  history  of  medicinal  treatment  in  the  far  past 
is  a  subject  of  marvel  and  of  somewhat  melancholy 
humor.  One  does  not  know  which  to  admire  most, 
the  credulity  of  the  patient  or  of  the  doctor.  A 
lot  of  quite  blind  empirical  treatment  has  been, 
without  doubt,  successful,  and  modern  science  is 
supplying  the  explanation  thereof;  but  most  of  the 
old  therapeutics  were  shots  in  the  dark,  or  at  best 
into  the  brown. 

Think  of  the  days  of  Squeers  and  Dotheboys 
Hall.  There  the  attempt  seems  to  have  been  to 
make  the  punishment  fit  the  crime,  but  this  was  only 
a  slight  caricature  of  the  treatment  of  those  days. 

I  have  been  reading  some  old  physicians'  pre- 
scriptions of  eighty  years  ago,  written  fully  with 
all  the  old  elaborate  Latin  directions.  The  super- 
ficial man  of  those  days  was  very  proud  of  those 
prescriptions,  which  none  but  a  skilled  pharmacist 
could  translate,  but  they  mostly  came  into  the  cate- 
gories of  mystery  and  of  bluff.  The  patient  got 
well,  or  he  didn't,  that  was  on  the  lap  of  the  gods, 
but  the  prescriptions  were  beautiful. 


PREFACE  IX 

After  centuries  of  darkness,  but  of  strenuous 
work  done  under  great  hindrances,  our  profession, 
helped  incalculably  by  the  great  men  who  have  gone, 
sees  the  light  streaming  through  from  many  sides. 
Our  old  masters  have  nobly  labored;  we  are  enter- 
ing into  their  labors,  and  mankind,  with  God*s  help, 
will  reap  the  harvest, 


CONTENTS 


flAPTE 
I. 

R 

The  Prolongation  of 

Life 

• 

PAGE 
1 

II. 

On    The    Value    and 
Foods     .       .       . 

Digestibility 

of 

44 

III. 

The   Prolongation   of 

Health 

• 

62 

IV. 

The    Treatment    and 

Prevention 

of 

Premature   Senility 

. 

• 

77 

V. 

Chronic     Bronchitis 

and     Bronchial 

Asthma 

1              •              •              • 

• 

145 

THE   ROAD  TO  A   HEALTHY 
OLD  AGE 

CHAPTER  I 
THE  PROLONGATION  OF  LIFE 

"Grant  to  life's  day  a  calm  unclouded  ending, 
An  eve  untouched  by  shadows  of  decay." 

What  may  be  the  nature  of  our  occupations  and 
interests  in  the  next  world,  we  know  not,  but  that 
the  night  cometh  when  no  man  can  work,  and  that 
death  cometh  to  us  all,  and  stoppeth  all  the  words 
and  works  we  love  so  well,  is  a  desperately  solemn 
fact. 

As  a  matter  of  absolute  certainty,  then,  we  have 
only  this  life  to  consider;  and  to  get  the  most  out 
of  it,  and  into  it,  is  the  main  problem  of  our  earthly 
existence. 

If  we  possess  high  altruistic  ideals  and  love  for 
our  brethren,  as  most  of  us  do,  we  must  endeavor 
to  get  the  most  out  of  it,  not  alone  for  ourselves, 


2         ROAD  TO  A  HEALTHY  OLD  AGE 

but  for  humanity  in  general.  The  monastic  con- 
templative life  of  religion,  if  not  converted  into 
charitable  altruistic  action,  affects  the  world  but 
little.  We  hold  our  powers,  our  thoughts,  and  our 
knowledge  in  trust  for  humanity;  and  as  they  de- 
pend on  our  health  and  on  the  continuance  of  life, 
then  we  should  feel  that  we  hold  in  trust  also. 

If  this  be  our  conviction,  we  must  feel  also  that 
the  years  of  our  working  powers  should  be  pro- 
longed to  the  uttermost;  and  so  a  long  life  and  a 
busy  one  becomes  our  chiefest  aim. 

The  wish  to  live  is  almost  universal,  but  not  al- 
ways from  the  right  motives;  the  self-indulgent 
luxurious  man  longs  for  the  continuance  of  his 
sensual  pleasures,  while  they  pari  passu  defeat  his 
unworthy  object.  The  rich  man  often  loves  his 
riches  too  dearly,  and,  hating  to  part  with  them, 
becomes  miserly,  and  so  fails  to  get  the  full  use 
and  right  enjoyment  from  them;  but  the  wise  and 
good  man  loves  his  life  and  hopes  for  long  days, 
so  that  they  may  be  spent  in  the  service  and  further- 
ance of  human  progress.  In  the  early  days  of 
Christianity  the  belief  that  the  world  was  to  come 
to  an  end  almost  immediately,  and  that  the  Second 
Coming  of  Christ  was  near,  blinded  their  eyes  to 
the  true  altruistic  teaching  of  their  Master. 


THE  PROLONGATION  OF  LIFE  3 

They  became  narrow  and  rather  selfish,  thinking 
that  they  alone  of  all  the  world  were  to  be  saved; 
of  true  philanthropy  in  any  practical  material  sense 
they  had  but  little.  There  were,  of  course,  striking 
exceptions,  like  St.  Peter  and  St.  Paul,  with  their 
great  missions  to  the  Gentiles,  but  the  mental  atti- 
tude of  the  majority  was  selfish  and  sectarian.  It 
is  an  extraordinary  fact  that  the  teaching  of  Christ 
and  of  His  disciples  did  little,  or  I  think  I  may  say 
almost  nothing,  for  the  material  development  or 
improvement  of  man's  work  or  physical  conditions. 
This  on  Christ's  part  was  probably  part  of  His 
scheme,  that  mankind  should  work  out  its  own 
evolution  and  happiness;  on  the  part  of  His  follow- 
ers, the  belief  in  His  immediate  Second  Coming 
made  useless  any  ideas  of  human  growth  or  of 
material  progress.  This  idea  lasted  for  centuries, 
and  I  think  it  may  be  truly  said  that  the  first  thou- 
sand years  after  Christ  were  materially  the  most 
barren  in  the  history  of  the  world;  civilization  was 
either  stagnant  or  retrograde. 

This  attitude  of  constant  expectation  has,  in  a 
measure,  paralyzed  the  churches  ever  since;  it  has 
concentrated  attention  far  too  much  on  the  future 
life,  and  has  diverted  it  to  a  great  extent  from  the 
problems   of   human   interests   and   growth   here. 


4        ROAD  TO  A  HEALTHY  OLD  AGE 

Thus  it  has  come  about  that  the  Church  of  to-day  is 
the  Church  of  the  well-to-do  and  of  the  contented ; 
the  lower  classes,  who  are  struggling  upwards  from 
poverty  and  misery,  find  little  to  help  them  in  their 
fight,  and,  indeed,  are  often  discouraged,  for  many 
preachers  tell  them  that  they  should  be  content  with 
what  they  presumptuously  call  their  appointed  lot, 
and  that  higher  worldly  aims  are  sinful.  The  man 
who  has  risen  from  the  ranks  is  still  looked  on  as 
an  outsider,  instead  of  a  man  to  be  honored.  The 
ninety-and-nine  just  persons  who  need  no  repent- 
ance are  ever  a  weighty  drag  on  the  wheels  of 
human  progress. 

It  has  been  cleverly  said  that,  under  the  law  of 
entail,  the  land  of  England  belonged  to  the  dead 
and  the  baby,  but  never  to  the  living  owner.  In 
much  the  same  way  many  good  folk  make  the  same 
muddle  of  their  lives  here;  they  spend  their  time 
in  regrets  for  the  past  and  in  contemplative  imagin- 
ings as  to  the  life  to  come,  and  oftentimes  neglect 
and  miss  their  mark  here.  As  far  as  we  know, 
this  life  is  our  great  opportunity,  and  what  we  make 
of  it  will  be  the  proof  of  our  success  or  of  our 
failure.  I  take  it  that  the  real  passport  into  the 
world  to  come  will  not  be  the  nature  of  our  spiritual 
introspections  here,  but  what  we  have  done  for  the 


THE  PROLONGATION  OF  LIFE  5 

good  of  our  times  and  of  our  brethren.  This  life 
we  must  use  with  all  our  highest  powers  for  the 
betterment  of  ourselves  and  of  humanity,  but  in 
working  for  humanity  we  must  try  to  attain  com- 
plete selflessness,  and  we  shall  need  also  endless 
patience ;  we  must  think  and  calculate,  not  in  years, 
but  in  generations,  and  we  must  rarely  expect  to 
see  results.  Alas !  our  faith  is  too  inelastic  and  too 
shortsighted ;  there  is  too  much  of  the  personal  and 
too  little  of  the  racial.  We  must  see  results,  or  aban- 
don the  experiment.  We  know  in  our  hearts  that 
God's  ways  and  times  are  not  as  ours,  but  we  can- 
not wait  for  God. 

Think  of  the  enormous  progress  in  knowledge 
and  science  that  the  last  two  centuries  have  brought 
to  us,  and  of  how  we  have  used  them.  That  know- 
ledge which  should  have  immeasurably  increased 
the  welfare  of  and  happiness  of  men  has  been  per- 
verted and  diverted  into  other  channels.  We  see 
as  the  result  the  most  wanton  and  destructive  war, 
the  greatest  suffering  and  the  greatest  loss  of  life 
that  the  world  has  ever  known.  Those  who  delib- 
erately planned  this  war  could  not  wait  for  the 
good  time  that  was  clearly  visible,  but  by  murder, 
rapine,  and  robbery  attempted  to  steal  a  march  on 
God  Himself. 


6         ROAD  TO  A  HEALTHY  OLD  AGE 

If  the  gospel  of  humanity  be  combined  with  the 
simple  primitive  teaching  of  the  gospel  of  Christ, 
then,  and  then  alone,  shall  we  begin  to  realize  the 
possibilities  of  man,  and  what  it  is  to  be  truly  the 
sons  of  God  and  to  be  worthy  of  that  great  and 
honorable  name. 

As  an  old  writer  says,  "  Man  was  not  sent  upon 
the  earth  to  prepare  himself  for  existence  in  another 
world;  he  was  sent  upon  the  earth  that  he  might 
beautify  it  as  a  dwelling,  and  subdue  it  to  his  use; 
that  he  might  exalt  his  intellectual  and  moral  powers 
until  he  had  attained  perfection,  and  had  raised 
himself  to  tHat  ideal  which  he  now  expresses  by  the 
name  of  God,  but  which,  however  sublime  it  may 
appear  to  our  weak  and  imperfect  minds,  is  far  be- 
low the  splendor  and  majesty  of  that  power  by 
whom  the  universe  was  made." 

We  have  in  the  past  set  up  an  anthropomorphic 
idol,  an  inheritance  partly  from  ancient  times,  when 
men  worshipped  devils  as  well  as  gods.  This  idol 
is  a  queer  and  impossible  mixture  of  love  and  ven- 
geance, of  mercy  and  cruelty,  of  justice  and  oppres- 
sion, and  we  called  it  God.  How  shall  we  be  for- 
given the  profanity  of  this  insult?  Fortunately 
the  insult  has  been  offered  not  to  a  semihuman 
jealous  being,  but  to  an  omniscience  with  whom  to 


THE  PROLONGATION  OF  LIFE  7 

comprehend  all  is  to  pardon  all,  that  sees  and  knows 
all  our  feebleness  and  blindness,  and  who  is  help- 
ing us  on,  in  spite  of  ourselves,  often,  with  our 
struggle  towards  the  light.  We  should  sit  down 
and  fearlessly,  humbly,  work  out  this  problem  for 
ourselves  as  far  as  it  can  be  accomplished  in  this 
earthly  tabernacle.  We  should  have  the  courage 
to  seek  and  find  our  merciful  and  all-wise  Creator 
in  the  world  around  us,  in  the  seed  and  in  the 
flower,  in  growth  and  in  decay,  in  life  and  in  death, 
and  in  the  slow  but  sure  evolution  of  the  wisdom 
and  goodness  of  man. 

Not  the  degradation  of  humanity,  not  the  sins 
and  errors  of  the  history  of  his  race,  but  the  bright 
dawning  of  new  hopes  and  new  powers,  and  his 
glorious  possibilities,  should  be  our  constant  theme. 
If  you  make  the  main  teaching  of  your  sermons  to 
boys  and  girls  the  fact  that  they  were  conceived  in 
sin  and  that  they  are  miserable  sinners,  they  will 
probably  and  instinctively  disbelieve  you ;  but  if  they 
believe  you,  they  will  start  the  great  adventure  of 
life  handicapped  by  a  moral  extinguisher  on  their 
unlucky  heads,  and  much  of  their  motive  power 
will  be  wasted.  As  evolution  has  been  the  law  and 
method  of  the  great  Creator  in  the  material  develop- 
ment of  the  universe,  so  must  it  also  be  in  the 


8        ROAD  TO  A  HEALTHY  OLD  AGE 

spiritual  and  physical  growth  of  man.  Not  the  man 
who  preaches  God  as  the  inexorable  judge  and 
avenger  of  sinners,  but  the  man  who  shows  God 
to  be  the  loving  Father  of  us  all.  Who  would  not 
that  any  should  perish,  but  that  all  should  come  to 
the  knowledge  of  His  truth,  is  the  man  who  preaches 
the  gospel  of  Christ  and  humanity. 

Some  prejudiced  person  will  surely  say  here, 
religion  and  science  were  always  enemies,  but  this 
is  false.  It  is  science  and  superstition  that  are  an- 
tagonists, and  often  bitter  ones.  All  truth  comes 
from  God,  and  is  for  our  use,  whether  of  religion 
or  science. 

Solomon,  with  his  marvellous  insight,  says, 
"  Where  there  is  no  vision  the  people  perish."  It 
is  the  history  of  all  religions  that  as  they  grow  into 
priest-managed  rigid  machines,  the  underlying 
spiritual  truths,  the  visions,  get  more  and  more 
obscured,  while  the  people  turn  away  to  other  re- 
ligions or  perish. 

This  seems  to  me  the  great  danger  of  our  present 
times.  In  the  awful  inhumanity  and  wickedness  of 
these  last  three  years  of  war,  we  see  the  Lutheran 
machine  in  Germany  in  its  fullest  vigor  and  in  its 
fullest  iniquity,  but  the  vision  ?    Mon  Dieu ! 


THE  PROLONGATION  OF  LIFE  9 

Our  own  Church  shows  many  signs  of  spiritual 
healthy  awakening,  but  it  will  have  to  throw  off 
a  lot  of  its  priest-made  traditional  accretions  be- 
fore it  can  become  in  any  real  sense  the  Church 
that  the  people  need  for  the  fostering  and  preserva- 
tion of  their  soul's  health. 

My  apology  for  the  foregoing  presumptuous 
sermon  must  be  this,  that  I  want  to  impress  on 
everyone  the  value  of  each  individual  life,  the  value 
of  its  well-being  and  of  its  continuance  to  the  ut- 
most limits,  and  to  emphasize  the  duty  we  owe  to 
God,  its  maker,  and  to  humanity. 

Our  ambition,  then,  and  our  duty  is  to  possess 
a  sound  mind  in  a  sound  body.  A  fairly  healthy 
active  mind  may  belong  to  a  diseased  body,  as  we 
have  seen  in  some  few  men  who  have  made  won- 
derful artistic  and  literary  careers,  but  they  are 
sorely  handicapped  by  the  burden  of  the  flesh,  and 
their  output  of  work  has  been  necessarily  curtailed; 
even  over  the  strongest  minds  an  unhealthy  body 
has  some  sad  influence.  Many  of  us,  who  start 
fair  in  the  race  of  life  and  who  live  by  the  work 
of  our  brains,  so  neglect  or  misuse  our  bodies  that 
disease  sooner  or  later  comes  to  us  and  impairs  our 
usefulness. 


10      ROAD  TO  A  HEALTHY  OLD  AGE 

On  the  other  hand,  the  man  rejoicing  in  his 
strength,  and  spending  his  days  in  games  and  in 
sport,  is  apt  to  let  his  mind  stand  still  and  to  be- 
come atrophied  from  disuse.  Cicero  says,  "  The 
body  is  apt  to  get  gross  from  work,  but  the  intellect 
becomes  nimbler  from  exercising  itself." 

The  philosophical  study  of  both  the  mind  and 
the  body  is  our  manifest  duty,  and  to  conduct  this 
business  effectually,  we  should  learn  carefully  the 
elementary  physiological  laws  that  govern  our 
being;  this  is  no  difficult  work  for  the  ordinary 
intelligent  mind. 

The  laws  that  belong  to  and  direct  our  eating 
and  our  drinking,  our  exercise  and  our  rest,  our 
circulation  and  our  respiration,  are  fairly  simple; 
but  they  must  be  studied,  and  applied  to  ourselves 
as  individuals,  for  we  are  none  of  us  built  on  uni- 
versal lines.  As  we  begin  to  get  old,  our  idiosyn- 
crasies especially  become  more  marked.  The  foods 
that  agree  with  us,  and  the  drinks,  are  not  always 
as  they  were,  and  the  amount  of  exercise  and  sleep 
that  are  good  for  us  vary  considerably.  The  un- 
wise physician  who  has  studied  medicine  more  than 
men  is  always  trying  to  classify  us  and  to  tar  every- 
one with  the  same  brush.  As  an  example,  a  witty 
American  lady  was  consulting  one  of  our  stomach 


THE  PROLONGATION  OF  LIFE  ii 

specialists  for  chronic  dyspepsia;  he,  with  more 
knowledge  than  wisdom,  began  to  lay  down  a  rigid 
rule  of  diet,  before  asking  her  for  her  own  experi- 
ences. She  intervened  with  this  characteristic  re- 
mark, "  Say,  Doc,  are  you  running  this  stomach, 
or  am  I  ?  "  A  fair  criticism.  The  foods  we  eat, 
the  drinks  we  drink,  even  the  air  we  breathe,  are 
mostly  under  our  own  control,  and  we  should  care- 
fully study  their  properties  and  their  laws  as  they 
affect  us  personally.  To  prepare  for  and  keep  the 
mind  fixed  on  our  later  years  is  a  policy  of  perfec- 
tion that  one  can  hardly  look  for  in  busy  sanguine 
youth;  but,  still,  they  should  feel  that  the  conse- 
quences of  their  life's  actions  and  conduct  will  have, 
in  the  end,  to  be  faced.  This  is  a  hard  saying,  and 
one  that  we  are  all  inclined  to  doubt  and  ignore,  but 
none  the  less  true — viz.,  that  for  all  the  sins  we 
commit,  moral  or  physiological,  for  all  the  sins 
known  and  unknown,  intentional  or  unintentional, 
Nature  will  one  day  send  in  the  bill,  and  a  bill 
that  will  have  to  be  paid. 

Most  of  us  seem  to  expect,  and  almost  all  of  us 
pray  for  a  divine  interposition  between  cause  and 
effect,  between  the  fault  and  its  consequence.  We 
expect  the  Almighty  to  stultify  Himself,  and  the 
laws  that  He  has  made,  by  making  frequent  in- 


12      ROAD  TO  A  HEALTHY  OLD  AGE 

dividual  exceptions  in  our  favor.  Is  this  reason- 
able? Would  it  elevate  our  idea  of  the  justice  of 
God  ?  or  would  it  be  for  our  ultimate  good  ?  Surely 
not.  That  God  is  a  God  of  mercy,  we  firmly  be- 
lieve; but  we  cannot  get  away  from  the  funda- 
mental law — as  a  man  sows,  he  shall  also  reap. 
There  may  be  ameliorations,  but  the  law  stands. 

After  all,  it  is  not  a  very  hard  road  that  we  are 
asked  to  travel.  It  is  only  to  live  soberly,  purely, 
and  wisely,  in  accordance  with  fairly  well-known 
laws ;  to  do  justice  and  mercy,  and  to  give  to  man- 
kind and  to  God  of  our  best,  whether  it  be  of  work 
and  the  fruit  of  our  bodies,  or  of  our  minds.  And 
if  we  do  these  things,  we  should,  with  God's  help, 
live  to  a  healthy  old  age  and  find  peace  at  the 
last. 

There  are,  of  course,  accidents  and  certain  ac- 
cidental illnesses  that  may  come  to  us  and  that  we 
can  never  entirely  guard  against,  such  as  the  in- 
fectious diseases,  the  diseases  brought  on  by  un- 
avoidable exposure  to  privation  and  chills,  and  the 
dread  but  so  far  unexplained  cancer;  there  are 
diseased  conditions  also  that  we  may  unluckily  in- 
herit, but  against  which  we  can,  nevertheless,  make 
a  good  fight.  The  man  who  inherits  a  morbid  con- 
stitution, and,  wisely  recognizing  his  danger  lives 


THE  PROLONGATION  OF  LIFE         13 

a  careful  life,  will  oftentimes  outlast  a  healthy  con- 
temporary in  the  race. 

Leaving  these  almost  unavoidable  ills  out  of  the 
question,  we  may  say,  with  a  fair  amount  of  cer- 
tainty, that  our  health  is  our  own,  that  the  diseases 
that  may  come  on  us  as  life  advances  are  more  or 
less  our  own  fault,  and  that  they  are  due  to  the 
breaking  of  physiological  laws.  In  the  great  fight 
of  life,  it  may  be  our  misfortune  to  be  knocked  out 
in  the  middle  rounds;  but  we  must  all  strive  and 
hope  to  fight  to  the  end,  to  fulfil  our  destiny,  and 
to  leave  a  record  of  some  good  work  behind. 
Habitual  intemperance  and  the  grosser  sins  of  life 
are  contraventions  of  the  moral  law:  they  carry 
their  story  and  fate  for  all  to  see;  but,  as  I  have 
said  above,  the  knowledge  and  sensible  application 
of  the  laws  of  health  will  carry  us  to  a  healthy  old 
age.  As  our  bodily  strength  and  activity  begin  to 
decline,  it  will  be  wise  for  us  to  get  overhauled  by 
a  good  physician,  by  one  especially  who  can  accu- 
rately estimate  the  condition  of  our  hearts  and 
arteries,  for  it  is  often  about  fifty  or  fifty-five  that 
we  need  to  make  a  change  in  our  food  and  in  our 
habits;  it  is  at  this  age  that  the  diseased  condition 
of  our  bloodvessels,  that  we  call  arterio-sclerosis, 
and  which  cuts  short  so  many  lives,  commences. 


14       ROAD  TO  A  HEALTHY  OLD  AGE 

and  it  is  in  these  early  days  that  so  much  can  be 
done  to  prevent  its  development.  This  I  shall  go 
into  more  fully  later  on,  but  I  mention  it  here,  as 
some  of  my  readers  may  get  no  further  than  this 
first  chapter. 

Let  us  now  seriously  consider  the  problems  which 
confront  everyone  who  has  survived  his  youth. 
Whatever  our  conception  of  the  future  life  may 
be,  human  nature  clings  to  the  existence  that  it 
knows.  "  Man  wants  but  little  here  below,  but 
wants  that  little  long,"  is  far  truer  than  the  original; 
and  as  we  grow  older,  often,  our  ties  to  life  in- 
crease, rather  than  diminish;  for  we  have  the  wel- 
fare of  our  children  and  grandchildren  much  at 
heart,  and  we  think,  rightly  or  wrongly,  that  they 
need  our  help  and  guidance.  It  is  only  in  the  last 
extreme  of  senile  feebleness  that  the  chains  that 
bind  us  to  life  are  loosened. 

But  the  mere  duration  of  life  is  not  a  worthy 
aim  in  itself.  What  pleasure  would  it  be  to  our- 
selves, and  what  use  to  others,  if  our  bodies  were 
afflicted  with  disease  and  if  our  minds  were  useless 
and  clouded  by  premature  decay  ?  To  carry  on  both 
our  health  and  our  mental  powers  unimpaired  must 
be  our  first  and  all-important  consideration.  As  the 
old  Greek  proverb  at  the  head  of  this  chapter  says, 


THE  PROLONGATION  OF  LIFE         15 

"  Know  and  study  yourself,'*  so  we  should,  with 
skilled  help,  make  our  own  individualities  our  study 
and  arrange  our  lives  in  accordance.  No  second- 
hand knowledge  nor  the  experience  of  others  will 
help  us  much,  for  as  no  two  cases  of  illness  are 
exactly  alike,  so  no  two  cases  of  ordinary  health 
run  on  quite  parallel  lines. 

Temperance  in  all  things  and  self-denial  must  be 
the  main  rules  of  our  life;  not  temperance  alone 
in  eating  and  drinking,  but  in  work  and  in  play. 
The  physical  or  bodily  dangers  of  approaching  age 
lie,  nowadays,  rather  in  the  direction  of  over- 
exertion. Neither  men  nor  women,  in  activity  or 
in  dress,  allow  themselves  to  sink  into  frumpage,  as 
did  our  early  Victorian  predecessors;  and  this,  if 
not  carried  to  extremes,  is  all  to  the  good.  Elderly 
people  can  do  a  lot  of  really  good  work  and  play, 
but  they  must  learn  to  do  them  both  quietly  and 
somewhat  slowly. 

"  The  pace  that  kills  "  is  a  proverb  that  applies  far 
more  to  age  than  to  youth.  This  thought  has  often 
come  to  me  through  a  long  experience.  What  a 
number  of  elderly  people  die,  if  I  may  use  such  an 
expression,  unnecessarily — that  is,  before  their  vital- 
ity and  strength  are  really  exhausted  and  before  their 
work  is  done ! 


i6       ROAD  TO  A  HEALTHY  OLD  AGE 

Hearts  that  are  able  to  meet  efficiently  all  the 
ordinary  demands  of  life  are  suddenly  called  on  to 
make  some  big  effort  of  strength  or  endurance,  and 
the  result  is  sudden  death  or  permanent  damage  to 
that  great  centre  of  our  life. 

There  are  three  things  which  old  age  must  re- 
ligiously avoid:  hurry,  physical  overstrain,  and 
mental  excitement,  such  as  anger  and  temper.  In- 
dignation we  cannot  help  oftentimes  feeling,  but  we 
must  never  let  ourselves  go  into  explosions  of  anger. 
While  avoiding  the  selfishness  of  the  pure  phleg- 
matic, we  must  still  more  shun  the  indulgence  in 
those  emotional  orgies  that  many  delight  in.  The 
late  Sir  Lauder  Brunton  on  this  topic  said,  "  The 
patients  should  be  warned  of  their  condition  and 
advised  to  lessen  strain,  either  mental  or  bodily,  if 
possible.  There  is  no  mental  strain  so  risky  as  that 
of  a  fit  of  anger,  and  yet  it  is  precisely  in  such  cases 
of  high  blood-pressure  that  the  temper  is  apt  to  be- 
come very  irritable,  and  angry  outbursts  may  occur 
on  very  slight  provocation,  altogether  out  of  pro- 
portion to  the  emotion  displayed."  If  our  hearts 
and  arteries  are  not  quite  sound,  heart  failure  or 
apoplexy  may  result. 

"  Be  ye  angry  and  sin  not "  has  always  seemed 
to  me  an  unfortunate  translation  of  St.  Paul's  words 


THE  PROLONGATION  OF  LIFE         17 

to  the  Ephesians.  It  is  really  a  repetition  of  the 
words  in  the  fourth  psalm,  "  Stand  in  awe  and  sin 
not,"  and  of  these  words  there  can  be  no  misinter- 
pretation. 

Horace  has  two  well-known  maxims  full  of  wis- 
dom, **  aequam  memento  rebus  in  arduis  servare 
mentem,"  which  may  be  roughly  translated : 

"  To  keep  an  equal  mind 
When  things  go  most  unkind, 
Remember  " 

and  "  Rebus  angustis  animosus  atque  fortis  appare," 
which  may  be  still  more  roughly  translated: 

"When  in  a  tightish  place, 
Don't  show  it  in  your  face. 
But  swagger  on." 

The  latter  applies  more  to  youth  than  to  age,  per- 
haps, and  lies  open,  possibly,  to  misapplication.  The 
happy  mean  that  should  exist,  in  old  age,  between 
an  indolence  that  rapidly  passes  into  an  all-round 
deterioration,  and  over-exertion,  is  not  easy  to  hit, 
but  it  is  certainly  better  to  err  on  the  side  of  wear- 
ing out  than  of  rusting  out.  Strictly  speaking, 
wearing  out  does  not  belong  so  much  to  old  age. 
In  youth  we  probably  wear  out  much  more  rapidly, 
but  restoration  or  new  growth  takes  place  still 
more  rapidly;  in  middle  life  the  balance  between 


i8       ROAD  TO  A  HEALTHY  OLD  AGE 

wear  and  restoration  is  approximately  equal.  In 
old  age  the  balance  is  reversed,  and  the  ever- 
changing  cells  of  our  body  renew  themselves  but 
slowly.  This,  I  think,  is  the  explanation  of  the  fact 
that  the  retired,  idle,  elderly  man  degenerates  more 
quickly  than  the  busy  one;  the  process  of  renewal 
is  not  stimulated,  and  so  slowly  or  quickly  ceases. 
Our  bodies  change  probably  several  times  during 
our  lives,  and  the  duration  of  our  existence  depends 
more  on  the  renewing  force  than  on  the  wear  and 
tear.  This  applies  as  much  to  our  brains  as  to  our 
bodies;  this  force  probably  lies  in  our  wonderful 
glandular  system,  for  these  glands  linked  up 
together  by  chemical  and  nervous  forces  supply,  by 
their  secretions  that  pass  into  the  blood,  the  stimuli 
for  the  whole  body. 

How  can  we  improve  on  the  words  of  Cicero? 

*'  We  must  stand  up  against  old  age  and  make 
up  its  drawbacks  by  taking  pains.  We  must  fight 
it  as  we  should  an  illness.  We  must  look  after  our 
health,  use  moderate  exercise,  and  take  just  enough 
food  and  drink  to  recruit,  but  not  to  overload  our 
strength.  Nor  is  it  the  body  alone  that  must  be 
supported,  but  still  more  the  intellect  and  the  soul; 
for  they  are  like  lamps — unless  you  feed  them  with 
oil,  they  too  go  out.'* 


THE  PROLONGATION  OF  LIFE  19 

To  go  rather  more  into  detail :  age  with  its  les- 
sened physical  work  and  activity  heeds  less  strong 
and  stimulating  food.  Our  output  of  work  should, 
in  a  reasonable  measure,  regulate  our  intake  of  food, 
the  quantity  as  well  as  the  quality.  The  neglect  of 
this  common-sense  wisdom  is  the  source  of  most  of 
the  disorders  and  incapacities  of  old  age.  We  les- 
sen our  exercise  and  our  general  activities,  but  we 
seldom  deny  ourselves  the  pleasure  of  the  table. 
'  If  we  keep  a  horse  idle  in  the  stable  for  some 
days,  and  give  him  the  same  quantity  of  oats  as 
he  had  when  in  full  work,  we  expect  ructions;  and 
if  on  the  top  of  the  oats  we  give  him  beans,  we 
expect  catastrophes.  In  like  manner  we,  as  we  get 
old,  leave  off  or  lessen  our  work,  but  often  take  the 
same  amount  and  sort  of  food.  After  a  while  we 
feel  out  of  sorts  and  unfit  for  the  little  we  have  to 
do ;  we  think  we  are  run  down — that  most  mislead- 
ing expression;  we  then  take  more  food  and  more 
stimulant,  with  the  inevitable  catastrophic  results. 
Why  should  our  wisdom  begin  and  end  with  horses  ? 

The  stream  of  life,  which  for  practical  purposes 
is  represented  by  the  stream  of  our  arterial  blood, 
should  be  kept  moving  quietly  and  regularly,  and 
all  the  excretory  organs  of  the  body  should  be  kept 
in  good  working  order  by  moderate  and  gentle  ex- 


20       ROAD  TO  A  HEALTHY  OLD  AGE 

ercise,  and  by  not  making  too  great  a  call  on  them. 
These  organs  are  the  scavengers  of  our  complicated 
bodies,  the  removers  of  our  dust-heaps  and  waste 
products,  and  they  are  absolutely  essential  to  life 
and  well-being.  They,  too,  grow  old  with  the  rest 
of  our  organs,  and  when  they  are  unable  to  carry 
out  the  work  demanded  of  them,  disease  and  death 
are  not  far  off. 

In  real  old  age  the  small  amount  of  food  required 
to  maintain  life  and  health  is  surprising,  and  I 
think  it  often  does  better  without  meat  altogether. 
Milk,  good  farinaceous  and  vegetable  foods,  eggs, 
and  white  fish  or  chicken,  give  all  that  is  needed. 

Old  people  are  very  apt  to  fall  into  grooves — i 
of  thought  and  of  exercise,  of  eating  and  of  drink- 
ing. If  these  grooves  are  reasonable  and  in  accord- 
ance with  physiological  laws,  it  is  unwise,  I  think, 
to  try  reforms.  i 

Nature  in  old  age  likes  to  run  on  conservative 
lines.  In  old  age,  it  would  seem  that  habits— even 
somewhat  doubtful  ones — are  better  than  no  habits 
at  all.  Without  them  old  people  often  drift  aim- 
lessly and  with  no  guide  on  to  the  rocks.  To  sum 
up,  temperance  must  go  hand  in  hand  with  self- 
denial,  and  knowledge  with  personal  experience. 

We  should  never  look  on  old  age  as  necessarily 


THE  PROLONGATION  OF  LIFE         21 

a  time  of  disease  and  decay,  but  rather  as  a  time  of 
peaceful  rest;  of  cessation  of  growth,  but  of  ripen- 
ing fruit.  The  knowledge  of  the  world  that  comes 
from  experience  should  keep  us  calm  and  con- 
tented and  full  of  hope  for  those  that  come  after 
us. 

Cicero,  in  his  charming  way,  said — writing  when 
he  was  quite  old — "  For  the  word  *  spring '  in  a 
way  suggests  youth,  and  points  to  the  harvest  to  be ; 
the  other  seasons  are  suited  for  the  reaping  and 
storing  of  crops.  Now,  the  harvest  of  old  age  is, 
as  I  have  often  said,  the  memory  and  rich  store  of 
blessings  laid  up  in  earlier  life.  Again,  all  things 
that  accord  with  nature  are  to  be  counted  as  good. 
But  what  can  be  more  in  accordance  with  nature 
than  for  old  men  to  die?  A  thing,  indeed,  which 
also  befalls  young  men,  though  nature  revolts  and 
fights  against  it.  Accordingly,  the  death  of  young 
men  seems  to  be  like  putting  out  a  great  fire  with  a 
deluge  of  water,  but  old  men  die  like  a  fire  going 
out  because  it  has  burnt  down  of  its  own  nature 
without  artificial  means.  Again,  just  as  apples,  when 
unripe,  are  torn  from  trees,  but  when  ripe  and  mel- 
low drop  down,  so  it  is  violence  that  takes  life  from 
young  men,  ripeness  from  old.  This  ripeness  is  so 
delightful  to  me,  that,  as  I  approach  nearer  to  death, 


22       ROAD  TO  A  HEALTHY  OLD  AGE 

I  seem,  as  it  were,  to  be  sighting  land,  and  to  be 
coming  to  port  at  last  after  a  long  voyage.** 

The  mental  disorders  and  dangers  of  old  age  be- 
long partly,  of  course,  to  their  state  of  bodily  health, 
and  to  the  sort  of  life  that  they  have  led;  but  apart 
from  these  more  or  less  physical  failings,  many  old 
people  are  apt  to  fall  into  a  state  of  selfishness  and 
— to  use  Jane  Austen's  happy  alliteration — "  pride 
and  prejudice."  They  take  a  pride  in  their  own 
>vork  and  achievements — a  natural  pride,  perhaps, 
but  one  which  a  strict  valuation  would  hardly  war- 
rant, and  which  posterity  would  probably  ignore; 
and  this  pride  naturally  leads  on  to  the  prejudging 
qi  the  newer  questions  of  the  day,  and  so  inevitably 
to  a  lack  of  progressive  thought  and  to  a  crystal- 
lization of  their  ideas  and  beHefs;  and  when  this 
crystallizing  process  is  complete,  where  do  they 
stand?  They  can  still  do  work,  and  fair  work, 
with  their  old  tools,  but,  unknown  to  themselves, 
they  have  joined  the  ranks  of  the  men  who  were. 
And,  after  all,  what  have  we  old  folks  to  be  proud 
of?  Have  not  our  successes  been  fewer  than  our 
failures?  and  the  work  left  undone  greater  than 
the  work  done? 

However  much  we  dislike  them,  we  cannot  get 
away  from  old  proverbs.    The  ever  popular  one  that 


THE  PROLONGATION  OF  LIFE         23 

says,  "  A  woman  is  as  old  as  she  looks  and  a  man 
as  old  as  he  feels,"  is  certainly  not  one  of  Solomon's, 
and  contains  rather  more  of  the  false  than  the  true. 
In  more  primitive  simple  times  it  may  have  had 
some  worth.  There  are  two  classes  of  women  who 
look  younger  than  their  age — one  in  whom^  despite 
of  white  hair  and  wrinkles,  the  light  of  unselfish 
humanity,  of  sympathy  and  of  true  wisdom,  shines 
undimmed;  and  one  which,  without  much  success, 
tries  to  postpone  the  appearances  of  age  by  art ;  but 
here  I  am  travelling  in  a  dangerous  volcanic  country, 
and  lest  evil  befall,  must  get  me  back  to  my  own 
sex  and  to  ground  which  is  more  sure  and  of  which 
I  pretend  to  know  something. 

That  a  man  is  as  old  as  he  feels  is  also  not  really 
correct,  for  this  feeling  belongs  chiefly  to  his  phy- 
sical side.  The  real  truth  is  that  he  is  as  old  as  he 
thinks.  If  he  think  old,  he  is  old ;  if  he  think  young, 
he  is  young,  whatever  the  tale  of  his  years.  This 
applies,  of  course,  to  both  sexes,  and  so  does  the 
next  paragraph. 

There  are  some  folks  who  seemingly  have  never 
been  young.  Hide-bound  by  convention  and  tradi- 
tion, they  have  had  no  really  separate  moral  exist- 
ence, and  they  can  scarcely  be  said  to  have  any  real 
individuality.    They  live  and  think  by  the  laws  of 


24       ROAD  TO  A  HEALTHY  OLD  AGE 

their  herd — of  their  sect.  These  are  the  shining 
lights  of  that  blessed  but  presumptuous  word  "  ortho- 
doxy " ;  these  are  the  worshippers  of  Mrs.  Grundy — 
nay,  they  are  Mrs.  Grundy,  and  so  their  own  wor- 
shippers. 

Without  doubt  they  make  for  a  certain  respect- 
able mediocrity,  and  it  may  even  be  said  that  they 
are  useful  as  brakes  to  a  too  enterprising  commun- 
ity; but  contented  and  ignorant  in  their  impenetra- 
ble shells,  they  make  for  nowhere  in  the  world's 
progress,  and  their  lives  and  deaths  pass  like  a  va- 
por, leaving  no  imprints  on  the  sands  of  their  times. 

The  man  or  woman,  on  the  other  hand,  who, 
refusing  to  become  old  and  with  the  experience  and 
accumulated  wisdom  of  years  as  a  check,  is  fully 
receptive  of  all  that  is  good  and  true  in  the  present, 
shines  out,  like  a  cheering  beacon  light,  to  those  who 
are  following  in  the  upward  path,  in  the  love  of 
knowledge,  and  in  the  love  of  humanity. 

What  a  dull,  hopeless,  unprogressive  world  it 
would  be  if  we  were  all  stock  size!  On  this  subject 
a  thoughtful  comparison  of  men  and  animals  be- 
comes very  interesting.  Animals  and  birds  that  live 
in  herds  and  flocks  all  strive  towards  uniformity; 
the  abnormal  one  is  hounded  out.  The  heterodox, 
non-conforming  rook,  for  instance,  has  a  short  and 


THE  PROLONGATION  OF  LIFE         25 

painful  existence.  This  leads  necessarily  towards 
the  establishment  of  a  definite,  rigid  type. 

This  is  for  them,  in  many  ways,  a  good  thing; 
the  herd  instinct  which  they  inherit  and  pass  on  en- 
ables them  to  act  collectively  for  purposes  of  attack 
or  defence,  and  it  governs  their  migrations  in  search 
of  food.  Thus  we  see  herds  of  feeble  deer  and 
cattle  flourish  and  increase,  while  the  solitary  beast 
of  prey  tends  to  die  out. 

So  far  all  is  good  for  herd  law,  and  for  the 
argument  for  uniformity,  but  there  is  no  progress. 
The  strength  and  wisdom  of  a  herd  of  cattle,  of  a 
flock  of  sheep,  is  no  greater  to-day  than  it  was  a 
thousand  years  ago,  nor  ever  will  be.  Certain  ani- 
mals, like  dogs  and  horses,  by  living  with  men, 
develop  a  wonderful  sort  of  knowledge  and  of 
reasoning  powers,  but,  separated  from  man,  they 
relapse  in  a  generation  or  two  to  their  old  wild 
standard.  This  is  the  difference  between  men  and 
animals,  that  we  can  pile  wisdom  on  wisdom,  skill 
on  skill,  experience  on  experience,  inherit  them  and 
accumulate  them,  and  this  I  take  to  be  the  proof  of 
our  divine  origin  and  also  of  our  divine  destiny; 
but  it  also  involves  the  recognition  of  our  divine  re- 
sponsibility, which  must  mean  continuous  progress 
and  growth. 


26       ROAD  TO  A  HEALTHY  OLD  AGE 

Many  of  us,  alas !  pile  up  experience  but  no  result- 
ant wisdom;  stagnant,  contented  with  our  small 
amount  of  knowledge,  we  say,  "  What  was  good 
enough  for  our  fathers  is  good  enough  for  us  " — 
the  most  hopeless  sentiment  in  the  world;  or  else 
either  by  our  conduct  or  by  our  obstinate  prejudices 
we  cause  our  weaker  brethren  to  offend,  and  so 
lower  the  tone  of  our  community. 

This  herd  instinct,  which  we  see  clearly  active 
and  beneficial  in  animals,  is  sneered  at  by  the 
thoughtless  man;  he  sarcastically  uses  the  expres- 
sion "  like  a  flock  of  sheep,"  for  instance,  but  on 
reflection  we  see  that  by  this  instinct,  for  the  most 
part,  the  average  man  and  woman  lives  and  thinks. 
What  is  Mrs.  Grundy  but,  from  the  social  point 
of  view,  herd  tradition  personified? 

And  to  our  shame  it  must  be  added  that  we  live 
below  our  herd  standard,  far  more  often  than  do 
the  animals. 

We  see  the  danger  and  futility  of  an  exclusive 
aim  at  uniformity,  but,  on  the  other  hand,  we  must 
not  lose  sight  of  its  value.  Many  of  us  have  not 
the  ability,  or  perhaps  the  leisure,  to  think  out  all 
our  moral  and  religious  problems  for  ourselves. 
We  have  to  take  for  granted  much  of  the  teaching 
and  wisdom  of  others,  and  to  follow  in  their  train. 


THE  PROLONGATION  OF  LIFE         27 

This  all  tends  to  the  establishment  of  public  opinion, 
of  a  useful  moral  order  or  code,  and  this  code 
governs  the  greater  part  of  every  community.  It 
has  not,  as  a  rule,  a  high  standard,  for  it  reflects 
only  the  opinion  of  the  mediocrity  or  of  something 
a  little  below  it ;  still,  it  helps  to  maintain  a  standard 
and  to  keep  many  a  man  on  the  rails.  But,  and  a 
very  important  but,  if  allowed  to  become  all-power- 
ful, it  becomes  the  bitter  enemy  of  progress. 

Herd  instinct  in  human  communities,  as  in  an- 
imals, is  unreasoning  often,  illogical,  and  sometimes 
brutal;  it  easily  passes  on  into  ostracism  and  per- 
secution, and  then  is  in  opposition  to  the  Divine 
Will. 

There  are  few  or  no  ideals  about  it,  but  it  makes 
for  safety,  and  so  must  be  treated  with  some  mea- 
sure of  respect  and  deference. 

It  is  quite  futile  to  run  quixotic  tilts  against  it. 
A  witty  American  speaker  said  lately :  "  As  an  up- 
holder of  order,  public  opinion  is  stronger  than  laws. 
Laws  have  to  be  executed;  public  opinion  executes 
itself,  and  often  keeps  people  more  virtuous  than 
the  laws  themselves.  The  fear  of  thy  neighbor  is 
the  beginning  of  wisdom."  This  is  largely  true,  but 
it  does  not  spell  Excelsior. 

Perhaps  its  worst  tendency  is  to  kill  or  check  in- 


i8       ROAD  TO  A  HEALTHY  OLD  AGE 

dividualism  and  enterprise.  "  Non-conformity  "  is 
a  word  I  dislike  to  use,  for  it  implies  only  a  nega- 
tion, and  not  a  principle,  but  individualism  is  and 
must  be  the  fons  et  origo  of  progress  and  evolution. 
No  orthodoxy  of  herd  tradition,  no  ecclesiastical 
uniformity,  is  going  to  save  a  soul  or  convert  a  sin- 
ner. Winston  Churchill,  in  his  powerful  book  "  The 
Inside  of  the  Cup,"  says :  "  The  central  paradox  in 
Christianity  consists  in  the  harmonizing  of  the  in- 
dividual and  socialistic  spirit;  and  this  removes  it 
as  far  from  the  present  political  doctrine  of  social- 
ism as  is  possible.  Christianity  looked  at  from  a 
certain  point  of  view — and  I  think  the  proper  point 
of  view — is  the  most  individualistic  of  religions, 
since  its  basic  principle  is  the  development  of  the 
individual  into  an  autonomous  being. 

"  No  religious  phrases,  no  formula  nor  catch- 
word has  any  saving  power.  The  effect  and  desire 
must  come  from  within,  from  the  individual  soul.*' 

William  Penn  also  says :  "  It  is  a  sad  reflection 
that  many  men  have  no  religion  at  all,  and  most 
men  have  none  of  their  own.  For  that  which  is 
the  religion  of  their  education  and  not  of  their  judg- 
ment is  the  religion  of  another  and  not  of  their 


own." 


Men  say  lightly  that  they  are  unbelievers,  but 


THE  PROLONGATION  OF  LIFE         29 

rarely  stop  to  think  what  it  is  they  don't  believe  in. 
They  may  not  believe  in  theology  as  it  has  been 
presented  to  them,  but  that  is  not  unbelief. 

No  man  can  get  away  from  the  conviction  that 
there  must  be  what  the  Freemasons  call  "  The  great 
Architect  of  the  Universe." 


There  is  no  unbelief;  whoever  plants  a  seed 
And  waits  to  see  it  push  away  the  sod 
Believes  in  God." 


Forms  and  creeds  are  but  the  swaddling-clothes 
of  wisdom's  and  religion's  infancy.  Until  we  can 
outgrow  them  and  in  a  measure  discard  them,  we 
shall  get  a  dim  view  only  of  the  higher  truths,  and 
of  the  light  that  shines  beyond. 

If  throughout  our  whole  life  we  clothe  ourselves 
with  them  as  with  a  garment,  they  will  too  often 
become  the  mere  cerements  of  the  soul's  decay  and 
death.  Arthur  Balfour,  in  his  introduction  to 
"  Theism  and  Humanism,"  says :  "  Progress,  though 
of  small  account  unless  it  touch  the  many,  gets  its 
vital  influence  always  from  the  few.  It  is  to  the 
patient  labors  of  these  rare  intelligences,  who  possess 
originality,  courage,  subtlety,  and  sympathy,  that 
we  must  look  for  the  gradual  working  out  of  a 
theory  of  the  universe,  which  shall  as  fully  satisfy 


30       ROAD  TO  A  HEALTHY  OLD  AGE 

our  reason  and  our  conscience  as  the  limitations  of 
our  faculties  permit."  Later  on,  as  a  sort  of  count- 
erpoise, he  very  wisely  says :  "  But  we  have  not  to 
do  with  intellectual  values  alone.  There  are  beliefs 
round  which  crystallize  complex  emotions,  aesthetic 
and  ethic,  which  play  no  small  part  in  our  highest 
life.  Without  the  beliefs,  the  emotions  would 
dwindle;  without  the  emotions  the  beliefs  would 
lose  their  worth.  Though  they  do  not  imply  each 
other  in  the  world  of  logic,  they  are  naturally  neces- 
sary in  the  world  of  values."  One  must  instinc- 
tively feel  the  truth  of  this  clear  and  wise  state- 
ment, but  one  must  also  remember  the  beliefs  and 
creeds  are  not  synonymous.  Beliefs  are  often  of 
divine  origin,  but  creeds  are  human  interpretations 
and  formulations  of  such  beliefs,  and  because  they 
are  human,  full  of  limitations  and  imperfections. 

In  developing  individualism,  we  must  be  careful 
to  avoid  the  somewhat  attractive  pitfalls  of  egotism 
and  egoism.  Self-absorbed  human  nature  soon  loses 
its  bearings  and  its  right  sense  of  proportion.  An 
egotist  has  been  wittily  described  as  "a  man  who 
insists  on  talking  about  himself,  when  you  want 
to  talk  about  yourself."  Naturally  he  is  very  apt 
to  degenerate  into  a  bore.  The  egoist  is  one  who, 
in  medical  language,  suffers  from  egoitis — that  is, 


THE  PROLONGATION  OF  LIFE         31 

from  an  inflammation  or  exaggeration  of  the  self, 
or  ego.  He  soon  becomes  a  mentally  diseased  man, 
and  often  a  nuisance  to  all  around  him.  Of  these 
two  the  egoist  is  by  far  the  worst.  One  has  known 
many  a  good  philanthropist  who,  in  seeking  the 
good  of  his  fellow-men,  has  become,  in  his  concen- 
tration and  enthusiasm,  a  sort  of  egotist,  but  one  can 
readily  pardon  him.  On  the  other  hand,  in  the 
egoist,  his  self-absorption,  his  self-aggrandizement, 
and  his  want  of  consideration  for  others,  tend  ever 
to  increase  and  to  overwhelm  him. 

The  true  unselfish  individual  seeks  not  his  own 
gain  or  glory,  but  strives  to  raise  the  tone,  the 
standard,  and  the  knowledge  of  his  community; 
and  in  doing  so  his  individualism  merges  and  de- 
velops into  the  higher  altruism,  which  I  take  to  be 
the  way  of  Christ.  He  seeks  after,  and  often 
grasps,  the  divine  essence  that  lies  hidden  in  us 
all. 

As  we  grow  older,  and  as  the  cares,  the  tentacles, 
and  passions  of  earlier  life  slip  away  from  us,  the 
first  feeling  of  a  wise  man  should  be  to  rejoice  in 
his  freedom,  in  the  emancipation  from  the  octopus- 
like arms  of  the  world  and  the  flesh.  The  unwise 
man  often  resents  his  freedom,  and  in  his  efforts 
to  get  back  into  his  former  bondage  and  to  rekindle 


32       ROAD  TO  A  HEALTHY  OLD  AGE 

spent  fires,  presents  rather  a  miserable  and  unedify- 
ing  spectacle. 

Let  us  aim  to  be  of  those  rare  intelligences  that 
Arthur  Balfour  describes;  let  us  aim  to  use  the 
wisdom  that  has  come  to  us  from  years  of  expe- 
rience for  the  world,  for  ourselves,  and  for  the 
furtherance  of  the  Great  Architect's  plans.  "  The 
true  Wisdom,"  as  Stevenson  says,  "  is  always  to  be 
seasonable,  and  to  change  with  a  good  grace  in 
changing  circumstances.  To  love  playthings  as  a 
child,  to  lead  an  adventurous  and  honorable  youth, 
and  to  settle,  when  the  time  arrives,  into  a  green 
and  smiling  age,  is  to  be  a  good  artist  in  life.  Think 
of  these  two  pictures :  old  age  crabbed  and  selfish, 
hating  the  noise  of  children  and  laughter,  scorning 
all  opinions  but  those  of  himself  and  his  contempor- 
aries, and  in  the  end  sinking  into  the  grave  unloved, 
unmourned,  with  no  faith  in  the  intrinsic  goodness 
of  humanity,  and  with  little  in  his  God;  and  the 
other  picture — a  lovable  old  face,  over  which  ex- 
perience and  humility,  wisdom  and  unselfishness, 
strive  for  the  mastery. 

A  concrete  example  of  a  life  gone  wrong  and 
wasted  is  of  more  weight  than  many  words.  I 
have  known  well  and  watched  this  man  for  forty 
years.    He  had  the  fortune  or  misfortune  to  make 


THE  PROLONGATION  OF  LIFE         33 

a  comfortable  pile  by  the  time  he  was  thirty-five. 
He  was  a  keen,  capable,  tireless  Yorkshireman.  He 
then  retired  and  has  never  done  another  day's  work. 
He  was  proud  of  his  early  success,  and  has  since 
spent  his  time  in  crowing  on  his  own  dunghill  and 
in  bullying  his  family — occupations  not  uncommon 
and  clearly  attractive  to  the  human  male.  He  has, 
without  any  vice,  led  a  mildly  luxurious,  self- 
indulgent  life.  In  these  forty  years  I  don't  think 
he  has  done  a  thing  that  he  did  not  want  to  do.  He 
has  taken  no  real  interest  in  outside  things  and  has 
done  no  public  work.  His  intellectual  and  moral 
standards  have  not  moved  forward  one  inch.  Now 
at  seventy-seven,  though  his  bodily  health  is  excep- 
tionally good,  his  mind  is  a  chaotic  ruin.  Though 
he  has  a  son  fighting  in  France,  he  refuses  to  be- 
lieve that  we  are  at  war.  He  thinks  his  wife  is  his 
mother,  and  his  memory,  except  for  the  far-away 
events  of  his  early  life,  has  gone.  This  mental  de- 
cay is  not,  as  in  many  cases,  the  secondary  result  of 
organic  disease,  but  is  simply  atrophy  from  disuse. 
He  buried  his  talent  forty  years  ago,  and  it  is 
now  so  rusted  and  corroded  that,  as  a  talent,  it  is 
unrecognizable.  His  son  put  the  case  in  a  nutshell 
when  he  remarked:  "You  can't  expect  a  man  to 
do  nothing  for  forty  years,  and  not  to  pay  the 


34       ROAD  TO  A  HEALTHY  OLD  AGE 

price."  The  above  is  no  doubt  an  extreme  example, 
but  we  must  all  of  us  know  of  others  that  approach 
it.  How  rarely  we  realize  that  there  is  a  penalty 
to  pay  for  doing  nothing,  for  the  sins  of  omission! 
We  hear  a  lot  about  overworked  brains,  but  they 
generally  belong  to  underworked  or  perhaps  diseased 
bodies.  The  average  healthy  brain  has  somewhere 
in  it  a  sort  of  stopcock  apparatus,  that  shuts  off 
steam  before  mischief  is  done. 

This  brings  us  to  the  great  question  of  retire- 
ment from  profession  or  business  as  age  advances. 
Some  of  us  are  retired  compulsorily,  some  of  us 
retire  voluntarily  and  our  blood  is  on  our  own 
heads,  but  in  all  cases  it  is  what  a  Scotchman  would 
call  "  just  an  awfu'  risk."  The  momentum  acquired 
by  many  years  of  routine  work  is  not  to  be  despised, 
and  is  easily  lost  if  we  get  off  the  old  accustomed 
rails.  Some  men  are  so  fortunate  as  to  be  able  to 
fill  their  lives  with  new  interests  and  occupations, 
after  their  old  work  is  done,  but  they  are  the  excep- 
tions. For  the  average  man  retirement  means  a 
slackening  of  the  whole  machine,  but  especially  of 
the  mental  side.  The  old  proverb  that  says,  "  The 
retired  man  is  a  doomed  man,"  has  much  truth. 
One  would  expect  that  the  larger  part  of  our  muni- 
cipal work  and  government,  and  that  also  of  our 


THE  PROLONGATION  OF  LIFE         35 

philanthropic  institutions,  would  be  done  by  retired 
men,  but  how  rarely  we  see  it.  The  leading,  active 
parts  fall  mostly  into  the  hands  of  the  still  busy 
men,  and  I  suppose  the  reason  is  that  their  minds 
work  more  quickly  and  efficiently  than  the  minds 
of  those  who  are  out  of  harness.  The  retired  man 
has  often  no  appreciation  of  the  value  of  time,  and 
so  becomes  prodigal  of  it.  Yet  there  should  be  a  lot 
of  useful  work  that  the  idle  man  should  be  well 
able  to  do,  and  work  which  would  save  him  from 
deteriorating. 

Since  the  war  began,  there  are  thousands  of  posts 
which  have  been  efficiently  filled  by  the  men  on  the 
shelf,  for  the  nation's  good  and  for  their  own. 
The  much-bepraised  hobby  is  useful,  but  most  of 
them  give  too  little  intellectual  exercise.  It  is  far 
easier  for  the  unemployed  man  to  keep  his  body 
fit  than  his  mind,  and  yet  the  true  and  only  hap- 
piness of  our  later  years  hangs  on  this.  After  all, 
it  is  the  absence  of  incentive,  with  its  consequent 
lack  of  keenness,  that  is  the  real  trouble.  It  is  the 
old  difference  between  the  man  who  takes  a  walk  to 
get  an  appetite  for  his  breakfast  and  the  man  who 
takes  a  walk  to  get  a  breakfast  for  his  appetite. 
There  is  the  incentive  in  both  cases,  but  one  of 
very  unequal  force. 


36       ROAD  TO  A  HEALTHY  OLD  AGE 

The  eyes  of  the  coming  generations  are  upon  us, 
looking  for  help  and  guidance.  Let  us  show  them 
minds  wise  and  open  to  all  new  truths  and  develop- 
ments, and  let  us  not  allow  the  approach  of  age  to 
sink  ignominiously  into  its  reproach. 

To  revert  to  the  first  danger  of  old  age — selfish- 
ness. This  oftentimes  creeps  on  us  insidiously, 
though  the  accusation  of  such  a  thing  would  fill  us 
with  indignation;  but  it  is  there,  unless  we  keep  a 
very  keen  guard. 

Our  children  perhaps  spoil  us,  and  we  uncon- 
sciously slip  into  the  habit  of  thinking  that  the  tit- 
bits of  life  belong  to  us  as  a  right;  or,  living  alone, 
we  arrange  our  lives  on  a  mildly  luxurious  plan,  and 
then  think  ourselves  very  hardly  used  if  circum- 
stances break  into  and  disturb  the  monotonous  order 
of  our  existence.  We  may  perhaps  have  earned  a 
place  in  the  sun,  but  its  size  should  not  be  too  con- 
spicuous. 

The  pride  of  old  age — generally  a  false  pride — 
is  too  often  shown  in  our  attitude  towards  youth. 
We  often  set  an  undue  value  on  the  wisdom  that 
is  supposed  to  come  from  years  of  experience,  and 
we  expect  youth  to  accept  our  valuation  and  con- 
clusions without  question;  whereas  in  reality  we 
old  people  have  more  to  learn  from  the  young 


THE  PROLONGATION  OF  LIFE  37 

than  they  from  us.  Our  failures  and  disappoint- 
ments have  inevitably  blunted  the  keen  edge  of  our 
courage.  While  we  are  weighing  chances  and  see- 
ing all  the  lions  in  the  path,  youth,  with  its  fresher 
knowledge  and  greater,  if  blinder,  pluck,  will  often 
arrive,  Bacon  says :  "  Men  of  age  object  too  much, 
consult  too  long,  adventure  too  little,  repent  too 
soon,  and  seldom  drive  business  to  the  full-period." 

"  Let  not  him  that  putteth  on  his  armor  boast 
himself  as  he  that  putteth  it  off,"  is  excellent  advice 
for  youth ;  but  the  converse  is  equally  good  for  age : 
"  Let  not  him  that  putteth  off  his  armor  boast  of 
his  past  and  the  great  things  he  has  done,"  but 
rather  let  him  help  his  sons  and  successors  to  put 
on  better  armor  and  to  fight  a  better  fight.  The 
laudator  temporis  acti,  the  man  who  says,  "  The 
country,  sir,  is  going  to  the  dogs,"  is  an  anachron- 
ism and  generally  a  bore,  and  to  be  this  is  no  longer 
the  privilege  of  old  age^  though  it  is  still  one  of  its 
great  temptations.  The  habitual  bore  has  for  all 
intents  and  purposes  outlived  his  usefulness.  He 
is  like  a  long  and  dreary  sermon,  the  persuasive 
power  of  which  is  in  inverse  proportion  to  its 
length. 

To  quote  once  more  Stevenson's  inimitable 
words :  "  In  short,  if  youth  is  not  quite  right  in 


38       ROAD  TO  A  HEALTHY  OLD  AGE 

its  opinions,  there  is  a  strong  probability  that  age 
is  not  much  more  so.  Undying  hope  is  co-ruler  of 
the  human  bosom  with  infalHble  credulity.  A  man 
finds  he  has  been  wrong  at  every  preceding  stage  of 
his  career  only  to  deduce  the  astonishing  conclusion 
that  he  is  at  last  entirely  right." 

Let  us,  then,  sink  our  selfishness  and  self-esteem, 
and  renew  our  youth  by  sympathy,  and  if  possible 
by  co-operation  with  our  sons;  and  not  only  by 
co-operation,  but  by  co-play.  What  a  poor  sort  of 
bond  there  is  between  sons  and  a  father  who  is 
regarded  as  little  more  than  a  paymaster!  But  if 
he  is  a  playmaster  also  and  can  lick  them  at  golf 
or  tennis,  he  is  a  much  respected  person,  and  one 
whose  opinion  will  carry  weight  all  roimd. 

Let  us,  then,  help  on  the  succeeding  race  by  en- 
couragement, by  advice  very  gently  given,  and  by 
occasionally  but  very  silently  putting  on  the  brakes ; 
and  let  us  never  forget  that,  in  the  words  of  the 
Irish  bull,  "  Their  future  is  all  in  front  of  them, 
while  ours,  alas !  is  behind  us.'* 

Now,  as  we  cross  that  ill-defined  boundary-line 
that  marks  the  advent  of  old  age,  we  must  not  make 
ourselves  miserable.  Remorse  we  must  have,  most 
of  us,  for  things  done  and  regrets,  all  of  us,  for 
things  left  undone,  and  for  all  those  great  ambitions 


THE  PROLONGATION  OF  LIFE  39 

and  hopes  that  have  gone  astray;  but  the  morbid 
analysis  of  the  *'  might-have-beens  "  leads  nowhere 
and  solves  nothing. 

Though  we  can  no  longer,  perhaps,  be  in  the 
fighting  line,  we  are  still  soldiers  in  the  great  army 
of  the  living.  If  we  cannot  ride  with  the  guns  or 
charge  with  the  bayonets  we  can  still  hold  the  fort, 
and  by  cheerfulness,  endurance,  and  unselfishness  can 
do  much  to  help  those  v/ho  are  fighting  the  great 
battle  of  life.  And  surely  the  life  has  been  worth 
'  the  living,  and  the  play  the  playing.  If  we  no  longer 
have  the  keen  sight  of  the  young  men  in  the  front 
row  of  the  stalls  for  all  the  beauties  of  the  stage 
and  its  players,  if  we  can  no  longer  catch  all  the 
delicate  points  of  the  dialogue,  yet  we,  who  see  from 
the  back  rows,  get  the  mise  en  scene  more  perfectly, 
and  see  things  in  truer  proportions  and  perspective. 

Listen  to  Cicero  once  more,  who  puts  these  words 
into  the  mouth  of  Cato,  then  eighty  years  of  age: 
"  My  wisdom  consists  in  the  fact  that  I  follow 
nature,  the  best  of  guides,  as  I  would  a  god,  and 
I  am  loyal  to  her  commands.  It  is  not  likely,  if  she 
has  written  the  rest  of  the  play  well,  that  she  has 
been  careless  about  the  last  act,  like  some  idle  poet. 
For  after  all  some  last  was  inevitable;  just  as  to  the 
berries  of  a  tree  and  to  the  fruits  of  the  earth  there 


40       ROAD  TO  A  HEALTHY  OLD  AGE 

Cometh  in  the  fulness  of  time  a  period  of  decay  and 
fall.  A  wise  man  will  not  make  a  grievance  of  this. 
To  rebel  against  nature,  is  not  that  to  fight  like  the 
giants  against  the  gods  ?  '* 

That  was  written  two  thousand  years  ago,  and 
I  hope  my  readers,  if  such  there  be,  will  pardon  me 
for  quoting  Robert  Louis  Stevenson  again,  that 
great  and  kindly  philosopher  of  our  own  time,  who, 
though  he  died  young,  seemed  to  have  grasped  the 
prophetic  vision  of  all  ages :  *'  Indeed,  by  the  report 
of  our  elders,  this  nervous  preparation  for  old  age 
is  only  trouble  thrown  away.  We  fall  on  guard,  and 
after  all,  it  is  a  friend  who  comes  to  meet  us.  After 
the  sun  is  down,  and  the  west  faded,  the  heavens 
begin  to  fill  with  shining  stars.  So,  as  we  grow  old, 
a  sort  of  equable  jog-trot  of  feeling  is  substituted 
for  the  violent  ups  and  downs  of  passion  and  dis- 
gust. The  same  influence  that  restrains  our  hopes 
quiets  our  apprehensions;  if  the  pleasures  are  less 
intense,  the  troubles  are  milder  and  more  tolerable; 
and,  in  a  word,  this  period  for  which  we  are  asked 
to  hoard  up  everything  as  for  a  time  of  famine  is 
in  its  own  right  the  richest,  easiest,  and  happiest  time 
of  our  life." 

Let  these  cheering  words  of  these  two  great  phi- 
losophers help  us  to  march  bravely  on,  and  to  use 


THE  PROLONGATION  OF  LIFE         41 

for  ourselves  and   for  others  the  very  best  that 
remains  to  us  of  life  and  work. 

To  som6  of  us  may  come  that  great  trial,  the  loss 
of  sight  or  of  hearing,  losses  which  seem  to  cut  us 
off,  to  a  great  extent,  from  the  joy  and  intercourse 
of  life,  and  which,  to  some  extent,  paralyze  our 
usefulness ;  but  even  then  we  must  fight  on  and  train 
the  remaining  senses  to  compensate  for  what  is 
lost.  As  a  comfort  to  these  I  must  quote  the  prayer 
from  Whittier's  beautiful  poem  "  My  Birthday  " ; 

"And  if  the  eye  must  fail  of  light, 
The  ear  forget  to  hear, 
Make  clearer  still  the  spirit's  sight, 
More  fine  the  inward  ear. 

*'  Be  near  me  in  each  hour  of  need. 
To  soothe,  or  cheer,  or  warn, 
And  down  these  slopes  of  sunset  lead 
As  up  the  hills  of  morn." 

When,  for  each  one  of  us,  the  sun  begins  to  set 
and  the  long  day  closes;  when  the  fear  of  death — 
that  phantom  born  of  faithlessness  and  doubt — 
stands  over  us,  we  must  steadfastly  look  through 
him  and  beyond  him  to  the  Better  Land,  to  the  Light 
that  never  fails;  for  this  is  not  our  home.  Let  us 
have  no  dread  of  the  so-called  pains  of  death.  They 
are  a  chimera.     Death  comes  kindly  and  gently  in 


42       ROAD  TO  A  HEALTHY  OLD  AGE 

unconsciousness,  in  coma,  or  in  sudden  failure  of 
the  heart.  During  the  last  three  centuries  in  Brit- 
ain and  America  the  outlook  on  the  future  life  has 
been  to  very  many  colored  and  clouded  by  the 
teaching  and  doctrines  of  Calvin.  I  doubt  if  two 
good  men  ever — unconsciously,  of  course — did 
more  to  blur  the  true  idea  of  God  as  an  all-loving 
Father  than  did  Calvin  and  John  Knox.  The  aspect 
of  religion  they  presented  has  now,  thank  God, 
nearly  died  out,  but  it  has  left  on  many  minds  an 
indelible  mark.  To  those  of  us  who  were  brought 
up  in  this  stern  subsection  of  the  Christian  religion, 
to  those  who  for  fear  of  death  were  all  their  life- 
time subject  to  bondage,  emancipation  has  been  very 
difficult.  But  looked  at  honestly  and  squarely,  this 
fear  of  death  implies  a  great  want  of  trust  in  our 
God. 

Compare  these  harsh  Calvinistic  beliefs  with  the 
happier  faith  of  Dante,  who  says :  "  In  this  age  the 
noble  soul  tenders  itself  unto  God,  and  awaits  the 
end  of  this  life  with  much  desire;  and  to  itself  it 
seems  that  it  goes  out  from  the  inn  to  return  to  the 
Father's  mansion;  to  itself  it  seems  to  have  come 
to  the  end  of  a  long  journey,  and  to  have  reached 
the  city;  to  itself  it  seems  to  have  crossed  the  wide 
sea  and  to  have  returned  to  port." 


THE  PROLONGATION  OF  LIFE         43 

Finally,  I  would  humbly  say  this:  If  the  old 
Greek  philosopher  could  look  on  death  as  his  last 
and  best  friend,  if  the  Buddhist  can  calmly  wait 
for  it,  and  if  the  Mohammedan  can  fearlessly  wel- 
come it,  surely  to  the  Christian  death  should  be  the 
apotheosis  of  his  existence,  the  janua  vitcB,  the  very 
gateway  into  knowledge  and  eternal  life. 

Listen  to  Whittier  again : 

"Far  off,  and  faint  as  echoes  of  a  dream, 
The  songs  of  boyhood  seem; 
Yet  on  our  autumn  boughs,  unflown  with  spring, 
The  evening  thrushes  sing. 

"The  hour  draws  near,  howe'er  delayed  and  late, 
When  at  the  eternal  gate 
We  leave  the  words  and  works  we  call  our  own. 
And  lift  void  hands  alone. 

"  For  love  to  fill,  our  nakedness  of  soul 
Brings  to  that  gate  no  toll; 
Giftless  we  come  to  Him  who  all  things  gives, 
And  live  because  He  lives." 


CHAPTER  II 

ON  THE  VALUE  AND  DIGESTIBILITY  OF 

FOODS 

As  our  whole  life  and  well-being  depend  on  the 
proper  digestion  of  our  food — air  and  water,  the 
two  other  necessities  of  life,  fortunately  needing 
no  such  elaborate  process  of  absorption — the  man- 
agement and  choice  of  our  food  becomes  a  matter 
of  the  greatest  importance. 

It  would  seem  to  the  casual  observer  that,  in 
youth  especially,  we  can  afford  to  make  foolish 
experiments  and  mistakes  in  our  diet,  to  go  too 
long  fasting,  to  take  far  too  much  at  one  time,  and 
to  eat  the  most  incongruous  mixtures ;  for  in  a  day 
or  two  we  seem  to  be  all  right  again.  Our  animal 
economy  is,  luckily  for  us,  so  wonderfully  made 
and  planned  that  it  is  able  to  meet  almost  all  de- 
mands and  emergencies  in  the  way  of  food,  and 
to  get  rid  of  the  resulting  waste  and  poisons;  but 
this  is  not  strictly  true.  Every  excess  in  eating  and 
drinking*,   every  unnatural   call  on   our   digestive 

44 


ON  THE  VALUE  OF  FOODS  45 

powers,  leaves  some  mark,  invisible  perhaps,  on  our 
reserve  of  power.  We  vary,  of  course,  as  individ- 
uals, enormously  in  our  powers  of  assimilation,  and 
in  the  immediate  penalties  we  have  to  pay  for  our 
mistakes ;  but  that  is  a  reason  why  each  man  should 
find  out  his  personal  equation,  and  so  in  early  life, 
while  recuperation  is  the  law,  learn  the  lessons  of 
self-denial  and  self -management.  The  man  who 
can  commit  excesses  apparently  with  impunity,  the 
man  who  boasts  that  he  has  never  had  a  day's  in- 
digestion in  his  life,  comes  to  grief  in  the  end  long 
before  his  proper  time.  It  would  seem  that  our 
wise  Creator  has  planned  us  for  imperfection  rather 
than  for  perfection,  but  in  reality  that  we  should 
attain  perfection  through  the  lessons  and  sufferings 
of  our  imperfections. 

As  our  years  advance  we  can  still  less  afford  to 
make  mistakes,  for  we  recover  more  slowly  or  not 
at  all,  and  our  excretory  organs,  that  clear  away 
our  rubbish-heaps,  are  not  up  to  any  new  or  addi- 
tional strain  of  work.  Hence  come  gout,  rheumatic 
affections,  kidney  disease,  and  nearly  all  the  troubles 
of  old  age. 

The  problem  is  not,  perhaps,  so  much  the  food,  as 
we  grow  older,  but  the  quantity.  Many  of  us,  in 
old  age,  improve  in  our  digestions ;  foods  that  used 


46       ROAD  TO  A  HEALTHY  OLD  AGE 

to  make  us  bilious,  for  instance,  we  can  often  digest 
quite  well.  The  man  or  woman,  the  sufferer  from 
sick-headaches  and  migraine,  generally  loses  them 
after  or  before  sixty.  It  is  difficult  to  explain  this, 
but  it  is  partly  due  to  lessened  nerve-strain. 

Let  us  briefly  consider  the  whole  progress  of 
digestion.  It  begins  in  the  choice  of  food;  it  then 
belongs  to  the  kitchen  or  the  cook.  If  we  can  con- 
trol these  first  two  problems,  we  come  to  our  bodies. 
The  first  and  very  important  question  arises.  Can 
we  masticate  our  food?  As  we  grow  older  our 
teeth  generally  become  less  perfect  in  their  work, 
and  it  is  here  that  a  good  dentist  can  do  so  much 
to  help  us.  But  how  often  we  avoid  him  and  put  off 
the  evil  day!  Though  we  may  have  lost  a  tooth 
here  and  there,  we  say  we  have  a  good  lot  left, 
but  a  healthy  tooth  without  a  vis-a-vis  in  the  oppo- 
site jaw  is  dancing  a  pas  seuL  It  may  be  an  inter- 
esting performance  for  the  tooth,  but  its  original 
purpose,  that  of  a  grinder,  is  not  being  fulfilled. 
In  fact,  many  old  people  do  better  with  no  teeth 
at  all,  than  with  some  here  and  there  that  do  not 
meet.  The  toothless  gum  often  becomes  in  time  a 
fairly  efficient  masticator,  but  its  food,  of  course, 
needs  common-sense  selection.  The  imperfect  masti- 
cation and  pulping  of  our  food  means  necessarily 


ON  THE  VALUE  OF  FOODS  47 

the  imperfect  mixing  of  that  food  with  the  saliva; 
the  saliva  is  not  merely  a  lubricant,  but  is  the  first 
agent  in  the  chemical  process  of  digestion,  for  it 
transforms  the  starch  of  our  food  into  something 
that  can  be  absorbed.  Imperfect  mastication  means, 
also,  that  the  food  is  swallowed  more  or  less  in 
lumps,  and  so  gets  imperfectly  mixed  with  the  gas- 
tric juice  in  the  stomach. 

Sir  Andrew  Clark^s  dictum  was  this  in  reference 
to  the  importance  of  good  mastication :  "  Thirty- 
two  teeth  in  one  mouth,  thirty-two  bites  to  every 
mouthful,  and  for  any  tooth  that  is  gone  the  number 
of  bites  to  be  proportionately  increased."  The  knife 
and  fork  can  be  made  to  do  much  of  the  work  of 
the  teeth,  but  they  do  not  supply  the  saliva.  Here 
one  must  say  a  word  on  the  variation  of  one's  diet. 
If  our  stomachs  were  like  a  big  test-tube,  into  which 
we  put  certain  ingredients  and  apply  to  them  certain 
chemical  agents  at  a  certain  temperature,  the  process 
of  digestion  would  be  shown  by  a  mere  chemical 
formula;  but  the  chemical  agents  that  do  our  work 
are  not  always  on  tap,  or  they  vary  in  amount  and 
in  strength.  They  are  produced  in  answer  to  the 
calls  of  our  nervous  system,  and  are  not  mere  auto- 
matic productions.  Thus  it  is  that  appetizing  food 
and  the  smell  of  well-cooked  food  acting  through 


48       ROAD  TO  A  HEALTHY  OLD  AGE 

our  nerves  cause  a  good  supply  of  saliva  in  our 
mouths  and  of  the  gastric  juices  in  our  stom- 
achs. 

This  explains  the  value  of  wholesome  condi- 
ments such  as  salt,  mustard,  and  pepper,  and  the 
different  effects  of  well  or  badly  cooked  food. 
Monotony  in  diet  has  a  dulling  effect  on  the  nerves 
that  govern  our  digestions,  just  as  continual  same- 
ness has  on  our  lives  generally.  We  may  design  a 
perfect  diet  from  a  chemical  point  of  view,  but 
the  monotony  of  it  will  cause  it  to  disagree  in  time. 
One  may  live  on  mutton-chops  and  rice-pudding 
and  feel  that  one  has  a  lump  of  lead  in  one^s  side, 
and  one  may  then  go  out  in  pleasant,  cheering  com- 
pany and  eat  one's  way  steadily  through  a  dinner 
of  many  and  varied  courses,  and  digest  it  perfectly, 
and  in  the  end  feel  all  the  better  for  it. 

Our  nature  seems  to  crave  for  change,  and  our 
stomachs  seem  the  better  occasionally  even  for  a 
shock.  Enjoyment  of  food  is  not  essential  for  di- 
gestion, but  is  a  great  help. 

In  support  of  this  argument  for  change,  one  can- 
not help  telling  the  story  of  the  Eton  boy  who  had 
to  write  an  essay  on  the  ancient  Greeks  (the  humor 
was  of  course  unconscious).  He  said:  "The  cus- 
tom that  a  man  should  have  only  one  wife  was  first 


ON  THE  VALUE  OF  FOODS  49 

instituted  by  the  Greeks;  they  called  it  monot- 
ony." 

This  dependence  of  our  digestive  powers  on  our 
nervous  system  points  also  to  other  things,  to  the 
importance  of  not  coming  to  our  meals  in  a  state 
of  nervous  or  physical  exhaustion.  Many  an  elderly 
person  does  far  better  with  a  rest  before  food  and 
after,  and  not  distracting  his  nerve  powers  by 
reading  continually  while  eating.  Anxiety,  grief, 
and  trouble,  as  we  know  to  our  cost,  affect  our 
digestions,  but  they  are  often  outside  our  con- 
trol. 

When  we  have  swallowed  our  food,  the  digestion 
by  the  gastric  juice  begins;  this  process  lasts  for 
varying  times,  according  to  the  nature  of  the  food, 
but  it  always  needs  time  for  its  work,  and  it  should 
not  be  hurried.  It  is  a  mistake  to  eat  one  course 
too  quickly  on  the  top  of  another,  and  it  is  a  mistake 
also  to  start  the  busy  actions  of  life  till  the  diges- 
tion is  well  on  its  way.  The  busy  man  should  make 
his  chief  meal  when  his  work  is  done,  while  the  idle 
man  had  better,  perhaps,  make  it  in  the  middle  of 
the  day.  This  last  applies  particularly  to  old  people, 
for  at  that  time  they  have  more  nerve  energy,  and 
their  sleep  at  night  is  better  for  not  having  partially 
digested  food  in  their  stomachs,    Really  old  people 


50       ROAD  TO  A  HEALTHY  OLD  AGE 

do  better,  I  think,  with  little  or  no  animal  food  in 
the  evening.  The  breakfast  and  the  early  dinner 
should  be  their  important  meals. 

The  question  of  the  nature  or  constituents  of  our 
diet  in  old  age  is  a  very  important  one.  Clearly 
by  nature  man  was  formed  for  a  mixed  diet,  and 
old  age  should  continue  it,  but  with  variations  and 
discretion.  As  I  have  said  in  my  first  chapter,  the 
quantity  of  one's  food  should  be  regulated  in  a  meas- 
ure by  the  mental  and  bodily  work  we  do,  and  in 
healthy  old  age  a  wise  quantity  is  of  more  import- 
ance than  quality ;  there  is  no  reason  why  we  should 
not  eat  a  moderate  quantity  of  meat,  but  if  there 
is  a  tendency  to  arterial  disease,  to  thickening  of 
our  arteries,  and  to  abnormally  increased  blood- 
pressure,  then  meat  should  be  very  sparingly  taken, 
and  that  not  every  day.  Beef,  pork,  and  veal  are 
more  injurious  probably  than  mutton  and  lamb. 
Here  the  diet  should  certainly  be  in  the  direction 
of  the  vegetarian,  with  the  supplement  of  eggs,  but- 
ter, cheese,  and  wholesome  white  fish,  such  as  soles, 
plaice,  whiting,  flounders,  and  brill.  Salmon  and 
mackerel  are  probably  rather  injurious. 

Of  the  vegetable  foods  the  pulses,  in  such  cases, 
such  as  beans  and  peas,  are  not  so  suitable  as  the 
cereals.    Old  folks  who  are  knocked  off  their  meat 


ON  THE  VALUE  OF  FOODS  51 

eat  as  a  rule  too  little  fat;  there  is  very  little  fat 
in  fish  or  in  birds,  but  with  red  meat  the  fat  is  so 
mixed  up  with  the  muscular  fibres  or  lean,  that  they 
eat  a  good  deal  without  knowing  it.  This  want  of 
fat  is  best  supplied  by  good  bacon,  hot  or  cold. 
Many  of  us  certainly  know  from  experience  that 
cold  boiled  bacon,  especially  in  winter,  is  the  whole- 
somest  form  of  animal  food  that  we  can  find.  Dr. 
Harry  Campbell  says  this :  "  The  ideal  dietary,  the 
most  suitable  diet  for  the  aged,  is  that  which  con- 
stitutes the  ideal  diet  for  man  in  general.  Such  a 
dietary  demands  (a)  moderation  in  quantity,  (b) 
simplicity  in  quality,  and  (c)  the  avoidance  of  those 
starchy  foods  which  are  apt  to  slip  into  the  stomach 
without  having  been  first  well  mixed  with  the 
saliva. 

"A  moderate  diet  is  one  just  sufficient  (supposing 
the  various  foodstuffs,  fats,  proteins,  etc.,  to  be 
properly  balanced)  to  maintain  a  person  at  the  light- 
est weight  consistent  with  the  most  perfect  health 
of  which  he  is  capable.  It  is  manifest  that  any  food 
over  and  above  this  sufficiency  can  do  no  good  and 
may  do  harm. 

"  By  a  simple  diet  is  meant  one  consisting  of 
such  items  as  bread,  plain  biscuits,  plain  puddings, 
plainly   cooked   vegetables,    fruit,    meat,   fish    (all 


521   ROAD  TO  A  HEALTHY  OLD  AGE 

plainly  cooked),  milk,  butter,  cheese  (such  as  Ched- 
dar), tea,  coffee,  cocoa,  salt.  Dishes  calculated  to 
tickle  the  palate  are  not  included  in  the  simple  diet. 
A  simple  diet  excludes  alcohol  and  all  condiments 
other  than  salt  and  occasionally  pepper  and  mustard. 

"  Avoidance  of  soft  starchy  foods.  All  through 
life  starchy  foods  should  be  taken,  as  far  as  pos- 
sible, in  a  form  compelling  thorough  mastica- 
tion." 

The  indigestibility  of  starchy  foods  is,  in  a  meas- 
ure, overcome  by  the  use  of  well-made  malted  or 
predigested  foods. 

The  scientific  study  of  diet  has  shown  that  certain 
quantities  are  necessary  for  the  maintaining  of  life; 
these  foods  and  quantities  represent  a  minimum, 
but  the  difficult  problem  is  to  find  out  how  much 
food,  and  what  is  necessary  for  the  maintenance 
of  life  in  its  fullest  activity,  so  that  the  greatest 
output  of  work  can  be  obtained.  The  overstepping 
of  this  amount,  when  long  continued,  leads  inevit- 
ably to  disease ;  the  diminution  leads  also  inevitably 
to  debility  and  inefficiency. 

These  quantities,  etc.,  have  been  worked  out  into 
what  are  called  *'  calories."  Roughly  a  small  calorie 
is  the  amount  of  heat  required  to  raise  a  gramme  of 
water  through  i°  Centigrade,  and  the  large  calorie 


ON  THE  VALUE  OF  FOODS  53 

(which  is  used  now  in  most  books  on  this  subject) 
is  a  thousand  small  calories.  This  is  no  place  for  a 
complete  scientific  explanation  of  this  subject,  but 
briefly  stated,  "  the  caloric  value  of  any  food  can 
be  determined  by  a  calorimeter,  and  is  a  measure 
of  the  energy  which  is  given  out  by  the  complete 
oxidation  of  the  substance."  The  above  is  a  quota- 
tion from  Dr.  Spriggs*  article  in  "A  System  of 
Diet  and  Dietetics,"  edited  by  Dr.  G.  A.  Sutherland, 
and  what  follows  is  also  from  the  same  article : 

"  We  have  seen  that  the  common  experience  of 
mankind  and  the  evidence  of  scientific  inquiry  agree 
that  a  sufficient  amount  of  food  must  be  taken  daily 
to  yield  from  2,500  to  3,000  calories.  When  we 
come  to  inquire  of  what  constituents  this  food 
should  consist,  we  find  a  general  agreement  upon 
fundamental  points,  but  a  great  deal  of  difference 
of  opinion  upon  others.  It  is  established  that  the 
dietary  of  man  should  include  all  three  food-stuffs, 
protein,  fat,  and  carbohydrate.  The  protein  is  es- 
sential: no  other  material  can  supply  the  loss  in- 
volved in  the  wear  and  tear  of  living  organs.  No 
other  food-stuff  can  entirely  supply  the  needs  of  an 
animal  as  protein  can  those  of  the  carnivora.  In 
the  case  of  man,  a  healthy  existence  cannot  be  sup- 
ported upon  protein  without  carbohydrate,  and  it 


54       ROAD  TO  A  HEALTHY  OLD  AGE 

is  a  great  advantage  to  him  to  have  fat  in  his  diet 
as  well,  since  fat  gives  a  greater  proportion  of 
energy,  weight  for  weight,  than  carbohydrate  or 
protein.  We  have  seen  that  protein  furnishes  mate- 
rial for  the  metabolism  of  structure,  whilst  carbo- 
hydrate and  fat,  and  any  protein  in  excess  of  that 
required  for  structure,  furnish  energy  for  the  meta- 
bolism of  function,  or  put  in  another  way,  fuel 
value  to  supply  heat  and  work.  Two  points  arise 
for  consideration:  first,  What  is  the  minimum 
amount  of  protein  which  is  essential  for  existence? 
and  secondly,  What  is  the  amount  which  is  desir- 
able in  order  to  maintain  the  body  in  the  highest 
degree  of  efficiency?  The  first  question  we  can 
answer  upon  the  evidence  before  us,  but  there  is 
considerable  disagreement  on  the  second.  Provided 
that  a  certain  minimum  of  protein  be  supplied,  and 
sufficient  caloric  value,  an  active  life  can  be  sup- 
ported upon  very  varying  proportions  of  the  three 
elements.  This  fact  must  be  clearly  borne  in  mind. 
Any  experiments  showing  that  men  can  live  and 
work  for  long  periods  upon  this  diet  or  upon  that, 
provided  that  the  constituents  satisfy  the  above 
fundamental  condition,  show  us  nothing  new.  Men 
have  existed  in  the  past,  in  the  vicissitudes  of  wealth 
and  poverty,  freedom  and  captivity,  upon  dietaries 


ON  THE  VALUE  OF  FOODS  55 

as  varied  in  both  quantity  and  quality  as  will  ever 
be  designed  by  experimentalists.  The  main  object 
of  our  inquiry  must  therefore  be  not  to  determine 
upon  how  much  or  how  little  a  man  can  live,  but 
what  are  the  proportions  of  the  food-stuffs  upon 
which  he  can  live  with  the  greatest  efficiency  and 
economy.'* 

It  must  be  evident  that,  as  our  work  lessens  and 
our  age  increases,  a  less  amount  of  food  than  the 
full  work  average  will  be  needed,  and  we  must 
remember  that  the  quantity  of  food  must  bear  some 
relation  to  the  weight  of  the  body.  In  the  above 
quotation  protein  (often  known  as  albumen)  is 
contained  in  all  animal  foods,  in  eggs,  and  in  smaller 
proportion  in  cereals  and  pulses. 

That  the  protein  is  derived  from  the  animal  or 
vegetable  source  is  not  of  much  consequence. 

The  carbohydrates  are  represented  by  what  we 
call  starchy  foods,  such  as  vegetables,  cereals,  pulses, 
and  sugar;  and  the  fats  are  the  fats  of  meats,  but- 
ter, animal-oils  derived  chiefly  from  fish,  and  to  a 
lesser  extent  vegetable  oils,  as  olive  oil.  The  amount 
of  protein  required  varies  a  good  deal  with  the 
nature  of  the  work  demanded. 

The  consideration  of  the  principles  on  which  diets 
are  constructed  has  led  us  to  the  following  propor- 


56       ROAD  TO  A  HEALTHY  OLD  AGE 

tions  of  food-stuffs  for  a  man  of  ii  stone,  leading 
a  life  of  moderate  activity : 

Protein       loo  gramraes=   410  calories. 

Fat  100       "        =430 

Carbohydrate    360        "         =1,480         " 

Total  heat  value =2,820         " 

This  is  almost  exactly  given  by  bread,  i  lb. ; 
meat,  4  ounces;  eggs,  4  ounces  (two  small  ones); 
cheese,  2  ounces;  potatoes,  i  lb.;  butter  or  other 
fat,  2  ounces;  milk,  J^  pi^t;  sugar,  y^  ounce. 

For  a  man  or  woman  of  9^  stone  an  adequate 
supply  would  be,  bread,  12  ounces;  meat,  6  ounces; 
potatoes,  J4  lb. ;  butter,  i  ounce ;  milk,  i  pint ; 
sugar,  I  ounce;  milk-pudding,  8  ounces;  soup,  i 
pint. 

This  is  the  ordinary  diet  of  St.  George's  Hospital, 
and  contains  protein,  90;  fat,  75;  carbohydrate, 
330;  calories,  2,400;  and  is  designed  and  is  suffi- 
cient for  those  doing  no  work. 

Dr.  Spriggs  says  in  conclusion  that  we  may  adopt 
Atwater's  standard  as  embodying  the  results  of 
modern  investigations  into  the  diet  of  adults : 

Protein  Calories 

For  women  with  light  muscular  work 90  2,400 

For  women  with  moderate  muscular  work 100  2,700 

For  men  without  muscular  work 100  2,700 

For  men  with  light  muscular  work 112  3,000 

For  men  with  moderate  muscular  work 125  3,500 

For  men  with  hard  muscular  work 150  4,500 


ON  THE  VALUE  OF  FOODS  57 

As  we  get  on  in  life  it  will  not  be  difficult  from 
the  foregoing  tables  to  construct  a  diet  which,  while 
giving  changes,  will  approximately  supply  all  we 
need,  and  which  will  not  by  excess  of  one  or  other 
constituent  put  too  great  a  strain  on  our  organs 
of  elimination,  such  as  the  kidneys.  The  amounts 
of  food  needed  will,  of  course,  vary  not  so  much 
with  the  number  of  one's  years  as  with  the  muscular 
work,  in  the  shape  of  exercise  that  we  are  able  to 
take. 

The  tables  by  Dr.  Spriggs  (page  58)  classify 
the  common  foods  according  as  their  energy-giving 
is  due  to  protein,  carbohydrate,  or  fat.  It  will  be 
noticed  that  milk  is  the  only  food  in  the  lists  which 
contains  a  good  proportion  of  all  three.  Cheese, 
Brazil  nuts,  and  bread,  are  represented  in  each  list 
and  contain  a  fair  proportion  of  at  least  two  of 
the  food-stuffs. 

For  experimental  purposes  these  foods  were 
tested  singly,  but  in  an  ordinary  mixed  diet  the  prob- 
lem becomes  a  good  deal  more  complicated.  The 
admixture  of  some  foods  will  probably  hasten  diges- 
tion, while  that  of  others  may  hinder  it;  these  gas- 
tronomic peculiarities  and  vagaries  are  discovera- 
ble only  by  personal  and  often  bitter  experi- 
ences. 


58       ROAD  TO  A  HEALTHY  OLD  AGE 


COMMON  FOODS  ARRANGED  IN  ORDER  ACCORDING  TO 
THEIR  VALUE  IN  PROTEIN,  CARBOHYDRATE,  AND 
FAT. 


Percentage  of  Total 
Heat  Value  of 
Food  Furnished  by 
its 

Protein. 


Per 
Cent. 

Lean  Beef  (boiled)  90 

Oysters    89 

Chicken   79 

Mackerel   50 

Skim  milk 37 

Eggs 32 

Beef  with   fat. ...  25 

Cheese    25 

Fat  ham    19 

Milk  19 

Bread 13 

Potatoes  II 

Boiled  rice   10 

Brazil  nuts 10 

Bacon 6 

Cream    5 

Bananas  5 

Butter    s 


Percentage  of  Total 
Heat  Value  of 
Food  Furnished  by 
its 

Fat. 


Per 
Cent. 

Butter    99 

Bacon     94 

Cream    87 

Brazil  nuts 86 

Fat  ham    81 

Fat  beef   75 

Cheese   73 

Eggs 68 

Boiled  mutton   ...  65 

Milk 52 

Mackerel   50 

Chicken    21 

Boiled  lean  beef. .  10 

Bread 6 

Bananas  5 

Potatoes I 


Percentage    of    Total 
Heat        Value       of 
Food  Furnished   by 
its 
Carbohydrate. 


Per 
Cent. 

Tapioca    (cooked) .  98 

Prunes    (dried)    .  .  97 

Figs    (dried)    . 93 

Rice  (boiled)    89 

Potatoes  (boiled)..  88 

Bread  81 

Peas   72 

Milk   29 

Cream    8 

Brazil  nuts 4 

Cheese  z 


If  we  take,  for  instance,  the  figures  of  lean  beef 
in  the  first  and  second  columns — viz., 


Lean  beef 90-f  10,  we  get  its  value. 

Chicken    79+21,  we  get  its  value. 

Bread    13+  6,  -fSi  its  value. 

Cheese    25+73,  +  2  its  value. 


By  roughly  arranging  foods  according  to  such  a 
table,  we  can  arrive  at  the  proper  balance  of  its 
various  constituents. 

Again  I  must  remind  my  readers  that  the  chem- 


ON  THE  VALUE  OF  FOODS  59 

ical  side  of  the  problem  is  not  the  only  one  to  study. 
Idiosyncrasy,  appetite  for  certain  foods,  distaste 
for  others,  and  personal  experience,  must  all  enter 
into  the  question.  The  appetite  for  certain  foods 
varies  much  at  different  periods  of  life.  Fat,  for 
instance,  is  abhorrent  to  many  children,  and  their 
lives  and  digestions  are  made  miserable  by  the 
parental  but  unscientific  command  to  "  clear  up 
their  plates." 

In  later  years  the  same  person  will  often  welcome 
fat  and  need  it.  Sugar,  again,  is  loved  by  children, 
scorned  often  by  middle  age,  which  supplies  its 
place  partly  by  wine  and  beer,  and  is  again  welcome 
and  often  very  useful  in  old  age,  for  it  helps  much 
to  keep  up  the  failing  heat  of  the  body.  In  hearts 
that  are  growing  old  and  feeble  good  cane-sugar  is 
a  direct  food  for  the  weakening  muscle  of  that  most 
important  organ.  Plain  sugar  added  to  food  or 
drink  is  more  digestible,  I  think,  than  sugar  in  the 
form  of  preserves — the  latter  is  more  likely  to  turn 
acid. 

The  digestibility  of  food  is  not  governed  neces- 
sarily by  its  chemical  composition,  and  here  our  own 
experience,  again,  and  that  of  others  should  be  a 
guide.  There  is  as  much  nourishing  material  in 
twice-cooked  as  in  once-cooked  meat,  but  most  peo- 


6o      ROAD  TO  A  HEALTHY  OLD  AGE 

pie  digest  it  with  far  more  difficulty,  and  one  does 
not  get  as  much  nourishment  out  of  a  food  that 
one's  stomach  manages  badly,  for  there  are  cer- 
tainly more  waste  products  produced  which  are 
never  absorbed. 

The  digestibility  of  new  and  stale  bread  varies 
much  with  most  people,  but  the  contents,  of  course, 
are  the  same  chemically.  Hot  fat  and  co^d  fat, 
again,  differ  much  in  their  wholesomeness.  To 
many  hot  fat  is  too  rich  and  makes  them  bilious; 
while  cold  fat  agrees  perfectly.  We  see  this  parti- 
cularly in  the  use  of  hot  and  cold  bacon. 

All  these  things  we  must  study  and  observe  each 
man  for  himself,  and  we  must  not  let  our  likes  and 
our  appetites  influence  and  sway  the  conclusions  of 
our  knowledge  and  of  our  personal  experience. 

The  following  table,  representing  the  experiments 
of  various  authors  and  compiled  from  Hutchinson's 
"  Food  and  the  Principles  of  Dietetics,"  gives  the 
length  of  time  which  the  various  foods  were  found 
to  remain  in  the  stomach : 

Hours.  Hours. 

Beef,   raw    2  Beef,  half  roasted 3 

"       boiled    3  "       roasted    4 

The  digestibility  of  mutton  has  been  found  to  be 
about  the  same  as  that  of  beef.     Pork  requires  a 


ON  THE  VALUE  OF  FOODS 


6i 


longer  time  than  mutton  and  beef,  and  veal  appears 
to  occupy  an  intermediate  position. 


Hours. 

Bread,  2^  oz 2^ 

Eggs,  two  lightly 

boiled 1% 

"       raw    2% 

"       poached  with 

butter 2% 

"       hard-boiled  ...  3 

"       as  an   omelette  3 

Fish,  7  oz 2^ 


Hours, 

Fish,  salt  4 

Apple,  raw,  5%  oz....    3% 

Cabbage,  5^  oz 3 

Cauliflower,  sVs  oz. . . .    2% 

Potatoes,  sYs  oz 2-2^ 

Lentils,  boiled,  5%  oz.    4 

Peas,  7  oz 4^ 

Rice,  boiled,  2^  oz.. . .    31^ 


CHAPTER  III 

THE  PROLONGATION  OF  HEALTH 

"The  truest  courage  lies, 

Not  in  unseeing  eyes, 
Owning  no  danger,  blindly  rushing  on; 

But  in  the  eye  that  sees 

To  grasp  the  golden  keys 
Of  power  and  circumstance,  and  make  them  one." 

After  the  attainment  of  maturity,  the  human  body 
in  health  remains  almost  at  the  same  level,  as  far 
as  physical  changes  are  concerned,  for  many  years. 
This  period  of  comparative  perfection  should  last 
for  forty  years  or  more.  There  are,  of  course, 
certain  slight  changes,  such  as  the  tendency  to  in- 
creased weight,  to  the  increase  of  fat,  and  to  the 
lessening  elasticity  of  heart  and  arteries;  but,  gen- 
erally speaking,  the  prime  of  life,  as  it  is  called,  the 
life  on  the  mountain-top,  should  go  on  for  about 
forty  years,  and  this  rule  should  apply  to  both 
bodily  and  mental  powers.  But  in  time  there  com- 
mences a  series  of  changes  which  are  known  as 
senile  decay. 

That  wise  physician  Milner  Fothergill  graphi- 

62 


THE  PROLONGATION  OF  HEALTH      63 

cally  describes  the  oncoming  of  this  condition  thus : 
"  Such  changes  are  easily  recognized  in  the  very 
old;  but  they  are  commonly  overlooked  until  their 
existence  is  almost  forced  upon  the  attention  of 
the  observer.  This  is  unfortunate,  as  it  is  often  a 
matter  of  great  moment,  in  the  recognition  of  the 
true  state  of  the  case,  to  be  able  to  detect  the  early 
evidences  of  impending  decay.  The  process  is 
normally  a  slow  one,  and  consequently  the  first 
changes  must  be  insidious  and  occult.  Not  only 
this,  but  they  will  be  very  slowly  developed.  This, 
however,  forms  no  reason  why  these  changes  should 
be  overlooked,  and  that  their  significance  be  omitted 
from  our  estimate. 

"  Many  people,  even  medical  men,  have  irrational 
notions  about  their  health  and  their  tissues.  The 
idea  that  there  may  be  atheroma  in  their  blood- 
vessels, that  there  is  a  commencing  hypertrophy  of 
the  heart,  or  that  their  kidneys  are  no  longer  sound, 
is  sufficient  not  only  to  perturb  them,  but  to  set 
them  to  work  at  once  to  prove,  at  least  to  their  own 
satisfaction,  that  they  are  free  from  the  slightest 
taint  of  commencing  decay.  If  it  were  merely  a 
subject  of  self-satisfaction  to  the  individual,  it 
would  matter  little;  but,  unfortunately,  such  atti- 
tude and  conduct  stand  in  the  way  of  a  proper  com- 


64      ROAD  TO  A  HEALTHY  OLD  AGE 

prehension  of  the  slow  and  gradual  progress  of  the 
chronic  changes.  These  prejudices  foster  ignor- 
ance; and  that  ignorance  often  assumes  an  aggres- 
sive character/' 

Since  that  was  written,  forty  years  ago,  our 
means  of  investigation  of  these  early  changes  have 
become  more  accurate  and  scientific,  and  our  means 
of  treatment  more  scientific  and  successful  also. 
It  is  only  in  these  early  stages  of  downward  progress 
that  we  can  expect  to  do  much  to  arrest  or  to  cure. 
If  the  symptoms  and  changes  are  allowed  to  pass 
on,  till  definite  structural  alteration  of  the  tissues 
arrives,  we  can  only  spend  our  efforts  in  patchwork 
repairs  and  in  making  the  inevitable  descent  as  easy 
as  possible.  The  mere  prolongation  of  life  were 
an  object  scarcely  worth  the  seeking,  if  we  could 
not  at  the  same  time  hope  to  prolong  the  health  and 
strength  of  both  body  and  mind. 

There  can  be  no  more  pleasing  sight  or  compan- 
ionship than  old  age,  free  from  suffering  of  body 
and  with  mind  serene  and  mature,  and  there  is 
certainly  no  more  distressing  sight  than  old  age 
borne  down  with  infirmity  and  with  mind  clouded 
and  unhappy. 

Job  says  in  his  inimitable  words :  "  Thou  shalt 
come  to  thy  grave  in  a  full  age,  like  as  a  shock  of 


THE  PROLONGATION  OF  HEALTH      65 

corn  Cometh  in  in  his  season."  This  should  be  our 
ideal,  to  help  our  Creator  towards  the  fulfilment  of 
His  handiwork.  Most  of  us  in  our  self-indulgence 
and  ignorance  spend  our  early  and  middle  years  in 
tearing  up  His  kindly  plans,  and  later  in  bewailing 
our  misfortunes.  Self-indulgence  or  any  form  of 
intemperance  is  a  sin  for  which  we  shall  have  to 
pay  here,  and  ignorance  of  such  vital  concerns  as 
our  health  and  well-being  comes  perilously  near  to 
a  sin,  for  it  is  God's  work  that  we  are  spoiling 
and  His  plans  that  we  are  frustrating;  and  can 
there  be  any  knowledge  more  important  or  more 
worth  the  getting  ?  Froude  says :  "  The  knowledge 
which  a  man  can  use  is  the  only  real  knowledge, 
the  only  knowledge  which  has  life  and  growth  in  it, 
and  which  converts  itself  into  practical  power. 
The  rest  hangs  like  dust  about  the  brain,  or  dries 
like  raindrops  off  the  stones." 

What  should  be  the  average  duration  of  life  in 
man  is  as  yet  an  unsettled  problem.  That  the  dura- 
tion of  his  life  has  much  increased  during  the  last 
hundred  years  is  undoubted,  as  the  statistics  of  all 
insurance  offices  show,  but  how  much  of  that  is  due 
to  lessened  infant  mortality  is  not  quite  clear.  That 
the  limit  of  life,  in  healthy  people  who  have  lived 
temperate,  careful  lives,  should  be  a  long  way  be- 


66       ROAD  TO  A  HEALTHY  OLD  AGE 

yond  three  score  years  and  ten  must  be  considered 
certain.  For  generations  as  a  race,  if  not  as  in- 
dividuals, we  have  done  nearly  all  in  our  power  to 
shorten  life,  by  overfeeding  generally,  by  over- 
stimulation often,  and  by  living  and  sleeping  in 
close,  badly  ventilated,  sunless,  unsanitary  houses. 
We  seem  to  have  lost  the  intuitive  knowledge  of 
what  is  good  and  bad  for  us,  that  most  animals  pos- 
sess. 

Some  enthusiasts  claim  that  vegetarianism  is  the 
one  rule  of  life,  but  observation  of  the  animal  king- 
dom does  not  support  any  such  theory.  The  raven, 
which  is  almost  exclusively  a  flesh-eating  bird,  lives 
nearly  one  hundred  years,  and  so  do  many  of  the 
larger  parrots,  which  are  vegetable  feeders.  What 
is  the  average  duration  of  life  in  the  large  carni- 
vora,  such  as  lions  and  tigers,  in  a  state  of  nature, 
it  is  almost  impossible  to  gauge,  but  the  domestic 
cat  is  not  of  long  life.  Elephants,  which  are  vege- 
tarian exclusively,  live  to  very  great  age,  150  to 
200  years,  but  horses  and  cattle,  also  vegetarians, 
seldom  live  beyond  25.  The  larger  tortoises,  which 
are  probably  the  longest  living  animals  known,  liv- 
ing 300  to  400  years,  are  some  of  them  insect  eaters 
and  some  vegetable  eaters.  That  their  various  or- 
gans,  such  as  mouths,  teeth,   limbs,   etc.,   are  all 


THE  PROLONGATION  OF  HEALTH      67 

planned  in  accordance  with  their  feeding  habits  goes 
as  a  matter  of  course. 

Roughly,  I  think,  there  exists  a  law  something 
like  this.  The  time  or  number  of  years  it  takes  for 
an  animal  to  arrive  at  full  maturity  regulates  the 
length  of  life.  An  elephant  takes  about  forty  years 
to  get  fully  mature ;  multiply  that  by  two,  and  that 
roughly  represents  his  period  of  full  strength. 
Another  similar  period  represents  his  gradual  de- 
cline; thus  40+80^80  makes  200  years,  which 
seems  to  be  his  limit.  A  dog  takes  2  to  2j4  years  to 
get  fully  mature;  2^^5+5  makes  I2j^.  A  horse 
5+ 10+ 10.  A  man  arrives  at  maturity  about  20. 
His  life  should  therefore  be  20^40+40,  which 
makes  100.  Whether  the  same  rough  law  holds 
good  in  birds  and  fishes  is  very  difficult  to  estab- 
lish. Some  fish,  as  carp,  which  grow  very  slowly 
to  a  great  size,  are  very  long-lived.  I  was  at  Ver- 
sailles in  1872,  and  in  one  of  the  ponds  there  a  big 
carp  came  up  to  be  fed,  as  they  have  done  for  years ; 
he  had  a  silver  plate  let  into  the  back  of  his  neck, 
which  showed  that  this  was  affixed  before  the  great 
French  Revolution,  so  he  must  have  been  eighty 
years  old  at  least. 

That  we,  as  a  race,  have  failed  to  make  the  most 
of  our  lives  must  be  regarded  as  a  certainty.    We 


68       ROAD  TO  A  HEALTHY  OLD  AGE 

all  of  us  know  men  and  women  over  ninety,  in  good 
health  and  in  possession  of  their  mental  faculties; 
and  as  sanitary,  physiological,  and  sociological 
science  grows,  so  must  the  duration  of  man's  life. 
Ninety  years  should  be  our  lowest  ambition. 

Old  age  is  inevitable,  and  death  of  course  is  in- 
evitable, but  that  miserable  fiasco  we  call  senility 
is  not  a  law  of  nature.  It  is,  on  the  contrary,  ev- 
idence and  proof  that  the  law  has  been  broken,  by 
ourselves,  by  our  forebears,  or  by  both,  and  it  em- 
phasizes the  importance  of  the  inheritance  that  we 
hand  on  to  our  successors.  But  are  we  to  remain 
stationary  and  satisfied  with  the  laws  of  nature  as 
we  read  them  to-day?  Is  there  to  be  no  evolution 
of  law  as  of  life?  What  we  call  law  is  much  the 
same  as  that  crippling  word  "  normal."  I  am  not 
speaking  now  about  a  normal  temperature  of  the 
body,  nor  about  the  normal  constitution  of  inorganic 
matter — though  as  for  these  things  we  may  be  able 
to  perceive  in  our  short  lives  what  is  only  a  tem- 
porary normal,  a  point  which  in  the  infinity  of  time 
may  be  slowly  rising — but  about  the  normal  in 
moral  thought,  in  philosophy,  and  in  the  science  of 
life.  An  actual  normal  point  is  in  reality  non- 
existent; it  merely  represents  an  approximate  pres- 
ent average.     Yet  it  is  one  of  those  words,  like 


THE  PROLONGATION  OF  HEALTH     69 

'*  orthodox,"  that  obsesses  us,  and  that  the  unthink- 
ing mind  regards  as  almost  sacred ;  but  the  reason- 
ing mind  cannot  fall  down  and  worship  an  approxi- 
mate average.  This  reverence  for  the  normal  is 
almost  a  gospel  of  despair;  it  produces  nothing  but 
mediocrity,  and  is  an  obstruction  in  the  path  of 
progress.  Is  the  old  age-limit  of  three  score  years 
and  ten,  dating  back  from  David,  to  remain  our 
normal  standard  still?  Surely  not.  The  average 
duration  of  life  and  working  years  is  steadily  in- 
creasing, and  their  limits  and  possibilities  are  not 
yet  in  sight.  The  normal  of  to-day  should  go  on 
steadily  growing  into  the  sub-normal  of  to-morrow ; 
we  may  have  to  think  in  years  or  centuries  in  place 
of  days,  but  a  healthy  discontent  or  a  natural  am- 
bition should  ever  be  driving  us  on  towards  an  ever- 
retreating  goal.  This  great  result  is  not  going  to 
be  attained  by  any  royal  or  easy  road,  by  this  or 
that  man's  medicine,  by  sour  milk  or  by  any  other 
food  fads,  but  by  an  all-round  application  of  scienti- 
fic and  logical  thought ;  by  improved  sanitation,  and 
by  a  wise  and  temperate  reform  of  all  that  belongs 
to  our  moral  and  physical  lives,  A  democracy,  the 
ideal  form  of  government,  is  good  or  bad  accord- 
ing to  the  character  of  the  people  who  form  it,  and 
is  an  unerring  reflection  of  the  average  of  their 


70       ROAD  TO  A  HEALTHY  OLD  AGE 

development;  but  it  nearly  always  contains  an 
aristocracy,  not  one  of  birth  or  wealth,  but  of  wis- 
dom and  knowledge,  which  is  working  to  raise  the 
standard  of  the  whole  body  politic.  In  like  manner 
we  physicians  and  all  the  aristocracy  of  Science 
should  ever  be  striving  to  raise  the  standard  of 
physical  and  mental  health  in  the  demos  of  the 
world,  which  is  in  a  measure  entrusted  to  our  care. 
That  dream,  the  elixir  of  life,  has  not  been  dis- 
covered, but  the  researches  into  the  action  of  the 
internal  glands,  which  Brown-Sequard  introduced 
to  the  world  on  June  i,  1889,  have  in  a  way  rev- 
olutionized medicine.  Biedl  eloquently  says :  "  As 
the  founder  of  the  doctrine  of  internal  secretion, 
Brown-Sequard  has  opened  to  Physiology  a  new 
and  fruitful  field  for  experiment;  he  has  paved  the 
way  for  the  right  understanding  of  many  patho- 
logical derangements;  and  he  has  pointed  out  a 
rational  and,  in  many  cases,  a  remarkably  success- 
ful method  of  treatment." 

Our  present  knowledge  of  these  glands  is  but 
superficial,  but  we  already  know  enough  to  see  their 
power  and  in  some  measure  their  possibilities  in  the 
treatment  and  postponement  of  senile  decay.  We 
shall  preach  and  we  shall  practise,  we  shall  fall,  as 
did  Metchnikoff,  by  the  way,  and  we  shall  be  jeered 


THE  PROLONGATION  OF  HEALTH     71 

at  as  mad  prophets  who  stultify  their  own  pro- 
phecies, but  in  the  true  spirit  of  altruism  we  must 
march  steadily  on,  remembering  that  "  tulit  alter 
honores  "  is  the  fate  of  all  reformers,  and  that  the 
welfare  of  the  many  can  only  come  from  the  work 
and  suffering  of  the  few. 

As  I  have  hinted  in  my  first  chapter,  senility, 
in  its  most  distressing  aspects,  is  not  the  result  of 
wearing  out  or  of  overwork.  Men  and  women  who 
work  till  they  drop  rarely  get  gradual  decay;  they 
die  suddenly  or  after  a  few  days'  illness.  Senility, 
scientifically  speaking,  means  the  cessation  of  re- 
newal, more  than  the  destruction  of  existing  tissues. 
Where  lies  the  centre  of  vital  power  and  what  it 
is  we  cannot  definitely  say,  but  it  is  almost  certain  /t" 
that  the  chief  agents  of  that  power  are  our  ductless 
glands,  and  it  is  their  failure  that  spells  senility. 

It  is  perhaps  hardly  necessary  to  draw  a  picture 
of  morbid  and  premature  old  age,  but  as  a  warning 
it  may  be  useful.  Firstly,  look  on  the  bodily  side: 
the  wasting,  slackening  muscles,  the  loss  of  spring 
and  activity,  the  slow,  shuffling  walk,  the  shortness 
of  breath,  the  pallor  and  sallowness  of  the  skin, 
and  the  vacuity  of  expression. 

The  more  unseen  bodily  infirmities  it  is  need- 
less to  enumerate.    Secondly,  look  on  the  still  more 


7a       ROAD  TO  A  HEALTHY  OLD  AGE 

painful  failure  of  the  spirit;  the  loss  of  memory 
for  the  most  important  things  of  the  day,  the  mind 
dwelling  only  in  the  far  past,  the  dulness  of  percep- 
tion, and  the  inability  to  take  in  any  new  ideas ;  the 
childish  irritability  and  impatience,  unrelieved,  as 
in  childhood,  by  intervals  of  sanguine  hopefulness. 
Many,  men  especially,  sink  into  anecdotage,  and 
when  that  anecdotage  becomes  a  perpetual  encore, 
they  become  the  worst  of  bores.  To  quote  Fother- 
gill  again  on  this  dismal  state :  "  The  prattling  child 
becomes  once  more  the  most  highly  appreciated 
companion;  and  the  garrulous  age  loves  to  pour 
into  uncritical  ears  long  tales  of  a  far  by-past  time. 
In  habits,  thoughts,  taste  and  food,  age  approaches 
youth.  The  process  of  evolution  has  given  place  to 
a  reversed  action,  or  involution.  The  higher  pro- 
cesses, which  are  slowly  developed,  and  which  are 
to  a  large  extent  outcomes  of  training  and  educa- 
tion, gradually  fade  out  and  lose  their  controlling 
power — the  last  to  develop  and  the  first  to  go — and 
the  most  vivid  and  enduring  impressions  of  the 
doting  brain  are  the  experiences  of  its  early  days, 
the  impressions  of  childhood.'* 

This  is  not  a  cheerful  outlook:  it  is  worse,  it  is 
humiliating;  but  surely  such  an  unhappy  and  un- 
timely ending  to  our  earthly  existence  cannot  be 


THE  PROLONGATION  OF  HEALTH     73 

in  accordance  with  the  Divine  purpose.  We  see 
it  not  in  the  animal  kingdom  (except  in  the  over- 
fed, pampered  domestic  pets  who  share  our  vices). 
The  true  cause,  without  doubt,  is  in  our  ignorance 
of  the  physiological  laws  of  health  (laws  which  the 
animals  seem  to  know  by  an  instinct  which  we 
have  lost) ;  in  intemperance,  in  overindulgence,  and 
still  more,  perhaps,  in  the  great  strain  of  social  or 
business  ambitions.  Our  lives  are  far  too  intense 
and  complicated.  The  mad  and  ineffectual  race 
for  life  becomes  too  often  the  triumphant  race  for 
death. 

A  thoughtful  reader  will  soon  say  something 
like  this :  "  I  have  known  men  and  women  who 
have  lived  the  most  exemplary  lives  as  regards 
morality  and  temperance,  but  whose  old  age  has 
been  clouded  and  miserable  " ;  and  doubtless  such 
is  the  case,  but  further  inquiries  will  show  that  one 
or  both  of  the  causes  are  morbid  constitutions  in- 
herited from  erring  forebears  or  an  ignorant  neg- 
lect of  the  primary  laws  of  health. 

Some  years  ago  I  knew  a  man  who  spent  his 
whole  life  in  philanthropic  and  religious  work,  trav- 
elling the  country,  preaching,  speaking,  and  organiz- 
ing; but  in  his  devotion  to  his  work  he  entirely 
neglected  his  body.    He  would  leave  home  immedi- 


74       ROAD  TO  A  HEALTHY  OLD  AGE 

ately  after  breakfast,  and  return  late  at  night,  hav- 
ing taken  no  food,  unless  some  friend  had  made  him 
share  his  meal.  At  a  little  over  sixty  he  became 
first  a  physical  wreck,  partially  paralyzed ;  and  later 
his  unusually  fine  religious  mind  became  that  of  a 
degraded  animal. 

The  thoughtful  regard  for  the  body  which  has 
been  given  us  is  just  as  much  a  duty  as  the  care 
of  the  soul.  When  one  looks  around  and  sees  these 
good  religious  and  unselfish  souls  breaking  down 
prematurely  and  their  lives  ending  in  apparent  fail- 
ure and  disease,  one  is  tempted  to  cry  out  against 
the  injustice  of  it  all;  but  God's  laws  and  punish- 
ments must  not  be  judged  by  a  few  individual  cases. 
These  poor  sufferers  are  like  those  on  whom  the 
tower  in  Siloam  fell — not  sinners  above  all  men 
that  dwelt  in  Jerusalem,  but  they  are  guide-posts  to 
show  that  all  God's  laws  must  be  obeyed,  and  not 
only  a  chosen  few  of  them. 

In  face  of  these  degenerative  changes  which  bring 
about  the  final  tragedy  of  so  many  valuable  lives, 
we  must  not  sit  still,  unhelping  and  impotent  spec- 
tators. Such  an  attitude  surely  is  both  unscientific 
and  unworthy  of  our  great  profession.  And  yet 
how  many  of  us,  doctors  and  laity  alike,  regard 
the  maladies  and  diseases  of  old  age  as  inevitable 


THE  PROLONGATION  OF  HEALTH     75 

and  unalterable.  Modern  medicine  is  disproving 
these  conclusions  every  day,  but  we  are  yet  only 
at  the  beginning  of  our  knowledge  in  matters  relat-' 
ing  to  the  cause  and  prevention  of  decay. 

I  have  used  the  above  words  "  maladies  "  and 
"  diseases  of  old  age  "  purposely,  for  it  is  the  mal- 
adies that  are  diseases  in  their  infancy,  and  it  is 
in  this  early  stage  that  progress  may  be  arrested 
and  in  not  a  few  cases  a  return  to  normal  health 
be  obtained.  The  functional  error  precedes,  often 
for  a  long  time,  the  structural  alteration  that  we 
call  disease,  and  it  is  in  this  stage,  of  course,  that 
our  curative  measures  will  be  the  more  successful. 

If  we  wish,  as  all  of  us  must  do,  to  further  the 
work  of  God,  the  great  Creator  of  all  life,  and  to 
be  with  Him  a  co-worker,  we  must  fix  in  our  minds 
that  His  watchword  and  method  is  progress;  not 
death  or  destruction.  The  tragedy,  as  we  call  it, 
of  death  is  a  delusion;  there  is  no  death  and  so  no 
tragedy. 

Progress  will  continue  after  we  cease  to  live  here, 
but  to  use  our  earthly  life  to  the  best  purpose  and 
to  prolong  it  to  the  uttermost  should  be  our  mani- 
fest duty  and  delight.  In  evolution  we  see  the  un- 
folding of  the  Divine  Will,  the  power  and  the  bene- 
ficent design,  all  marching,  in  spite  of  wars  and 


76      ROAD  TO  A  HEALTHY  OLD  AGE 

cataclysms,  harmoniously  for  the  good  of  our  race.. 
Evolution,  apart  from  religion,  is  God's  gospel  to 
the  world ;  it  is  the  history  of  our  past,  the  explana- 
tion of  our  present,  and  the  hope  and  glory  of  our 
future. 


CHAPTER  IV 

THE  TREATMENT  AND  PREVENTION  OF 
PREMATURE  SENILITY 

Forty  or  more  years  ago  surgery,  under  the  in- 
fluence of  Listerism,  started  a  new  life,  and  the 
world  stood  astounded  at  the  brilliancy  of  its 
achievements.  During  this  time  the  science  of  med- 
icine seemed  to  stand  still,  but  there  was  much 
silent  good  work  going  on  all  the  time,  and  for 
the  last  twenty  years  there  has  been  such  growth 
and  development  as  no  former  period  of  the  world's 
history  has  ever  seen.  Bacteriology,  organic  chem- 
istry, and  the  organic  remedies  chiefly  derived  from 
the  ductless  glands,  have  revolutionized  our  meth- 
ods, and  have  enormously  increased  our  powers 
over  disease,  and  perhaps  more  especially  over  the 
diseased  conditions  peculiar  to  the  elderly  and  the 
old. 

I  think  the  future  of  therapeutics  lies  chiefly  in 
the  direction  of  organic  remedies,  in  the  medicines 
which  are  more  or  less  native  to  the  human  body 
and  not  foreign  to  it.    I  should  be  the  last  to  dis- 

77 


78       ROAD  TO  A  HEALTHY  OLD  AGE 

parage  the  value  of  drugs  obtained  from  plants, 
such  as  strychnine,  digitalis,  aloes,  etc.,  but  they  are 
foreigners,  and  will  be  gradually  superseded,  I  be- 
lieve, by  those  remedies  which  are  more  nearly 
related  to  the  animal  organism.  Iron,  phosphorus, 
and  perhaps  arsenic,  stand  midway;  the  first  two 
are  natural  constituents  of  the  body,  and  should  be 
looked  upon  as  special  foods  and  not  as  drugs.  I 
make  an  earnest  appeal  to  my  medical  brethren  to 
study  closely  modern  physiological  therapeutics,  and 
not  to  be  content  with  the  old,  so-called  orthodox, 
routine  methods.  Our  watchword,  to  paraphrase 
the  old  French  proverb,  should  be  "  Progres, 
progres,  toujours  progres  et  quelquefois  I'au- 
dace.  " 

We  can  have  no  *'  Quicunque  vult "  among  our 
creeds.  The  past  is  ours  to  profit  by,  but  the 
future  is  ours  to  make.  In  therapeutics  we  must 
be  optimists,  for  we  carry  about  in  our  own  bodies 
most  of  the  remedies  we  shall  need.  Many  a  fall 
we  shall  get,  but — and  this  is  the  chief  thing — we 
must  always  be  found  in  the  saddle  again. 

I  think  we  may  safely  say  that  the  natural  term 
of  life,  since  David  wrote,  has  been  much  prolonged. 
The  term  to  ordinary  healthy  folk  should  be  nearer 
ninety  years   than   seventy,    and   the   extra   years 


PREMATURE  SENILITY  79 

should  not  be  years  of  labor  and  sorrow;  and 
yet  what  a  number  fail  to  reach  even  the  old 
goal! 

Dr.  de  Havilland  Hall,  who  may  be  considered 
one  of  the  first  authorities  on  both  arterio-sclerosis 
and  on  the  life  insurance  aspect  of  that  disease,  says 
that  though  the  average  duration  of  life  has  con- 
siderably increased  during  the  last  fifty  years,  there 
has  been  an  actual  increase  in  the  mortality-rate 
among  males  between  the  years  of  forty-five  and 
sixty-five;  and  that  between  the  ages  of  fifty-five 
and  sixty-five  one-third  of  the  total  deaths  are  due 
to  disease  of  the  heart  and  bloodvessels.  The  fear- 
ful mortality  from  cancer,  and  our  powerlessness 
in  face  of  it,  make  our  hearts  ache,  but  here  we 
have  probably  a  far  more  frequent  cause  of  death 
and  of  incapacity,  and  we  almost  ignore  it.  These 
statistics  are  obtained  from  the  Registrar-General's 
Reports,  and  are,  of  course,  beyond  dispute,  but  I 
should  roughly  estimate  that  50  per  cent,  of  the 
deaths  of  people  over  sixty  years  of  age  are  due 
to  these  causes,  to  Bright's  disease,  or  to  the  non- 
tubercular  chronic  chest  diseases  that  are  so  often 
mixed  up  with  them,  and  many  of  which  belong  to 
a  common  origin,  and  which  are  not  fully  or  scienti- 
fically classified  on  ordinary  death  certificates;  and 


8o      ROAD  TO  A  HEALTHY  OLD  AGE 

to  the  study  of  these  diseases,  then,  I  ask  my  readers 
to  accompany  me. 

The  critic,  even  the  friendly  critic,  will  perhaps 
say,  "  This  is  a  man  with  one  idea,  and  he  sees 
one  side  of  the  problem  only."  To  a  certain  extent 
I  admit  the  justice  of  this,  but  I  have  taken  my 
course  deliberately.  The  other  causes  of  premature 
and  diseased  old  age,  such  as  the  acute  febrile  dis- 
eases, pneumonia  and  influenza,  and  all  the  various 
forms  of  malignant  disease,  are  to  a  large  extent 
outside  our  control,  and  compared  numerically  to 
arterio-sclerosis  are  almost  negligible.  It  has  been 
my  fortune,  good  or  bad,  to  hear  many  sermons 
and  many  preachers,  and  I  have  been  forced  to  this 
conclusion,  that  the  ordinary  preacher  who  tries 
to  cover  the  whole  ground,  who  divides  his  lengthy 
sermon  into  divisions  and  subdivisions,  rarely  gets 
his  message  home;  after  a  few  minutes  the  drowsy 
nebulosity  of  his  hearers'  minds  passes  into  com- 
plete intellectual  sleep. 

"The  braw  words  rumm*le  ower  his  heid. 
Nor  steir  the  sleeper; 
And  in  their  restin'  graves  the  deid 
Sleep  aye  the  deeper." 

Stevenson. 

But  the  preacher  who  is  content,  in  a  short  ser- 
mon, to  make  one  or  two  good  points,  to  touch 


PREMATURE  SENIUTY  8i 

those  points  with  a  little  spice  or  mustard  and  to 
ram  them  home,  is  the  man  who  fulfils  his  mission. 
Such  must  be  my  excuse  for  the  limitations  of  this 
little  book. 

How,  then,  shall  we  approach  this  great  fight? 
Most  of  us  are  apt  to  look  upon  diseases  and  their 
beginnings  as  mere  happenings,  as  the  unlucky 
chances  of  life,  but  surely  it  is  not  so. 

There  are  some  diseases  that  come  from  with- 
out, as  the  infectious  fevers,  against  which  we  can- 
not entirely  guard,  but  the  ordinary  diseases  are 
the  logical  results  of  a  long  chain  of  causes,  most 
of  which  are  under  our  control.  Even  the  infections 
from  without  become  diseases  only  when  our  powers 
of  resistance  are  absent  or  their  tide  at  a  low  ebb. 
The  first  thing  we  must  do,  then,  is  to  inquire  care- 
fully into  causes,  into  the  way  of  life,  and  into 
hereditary  tendencies.  We  must  try  to  remove  ex- 
cessive pressure  of  bodily  or  mental  work,  improper 
feeding,  careless  eating  and  drinking,  and  we  must 
insure  plenty  of  quiet  rest.  It  goes  without  saying 
that  to  insure  any  success,  we  must  get  our  patients* 
honest  and  willing  co-operation.  Without  this  we 
can  do  but  little.  Secondly,  I  would  say  that  every 
man  and  woman  of  fifty  years  of  age  should  have 
their  hearts  and  arteries  carefully  examined.     A 


82       ROAD  TO  A  HEALTHY  OLD  AGE 

rise  of  arterial  tension  or  blood-pressure  is  almost 
certainly  the  earliest  symptom  that  we  can  detect 
and  rely  on  in  threatening  diffuse  arterio-sclerosis 
'or  thickening  of  the  arteries. 

Arterial  tension  may  be  described  thus:  During 
the  resting-time  of  the  heart,  between  each  beat, 
the  circulation  of  the  blood  is  maintained  by  the 
contractile  power  of  the  arteries,  which  steadily 
urges  the  blood  onward  into  the  capillary  vessels 
and  so  into  the  veins.  This  power  is  known  as 
arterial  tension  or  pressure,  and  it  is  estimated 
fairly  accurately  by  the  syphygmomanometer.  A 
large  number  of  observations  have  taught  us  what 
is  the  average  pressure  at  different  ages  of  life, 
and  thus  we  are  able  to  talk  about  a  normal  or  ab- 
normal pressure.  To  fix  in  our  minds  a  clear  idea 
of  the  physiology  of  the  arterial  system  I  cannot 
do  better  than  quote  Sir  Lauder  Brunton  (Lancet, 
VIL  xxvi.  15)  :  "  The  whole  of  the  arterial  system 
from  the  aorta  down  to  the  smallest  arterioles  has 
the  power  of  contraction,  but  there  is  much  more 
elasticity  and  less  contractility  in  the  aorta  than  in 
the  arterioles,  where  the  contractility  is  great  and 
the  elasticity  comparatively  slight.  The  whole  sys- 
tem is  richly  supplied  with  nerves,  some  of  which, 
the  yasQ-motor  nerves,  induce  contraction,  while  the 


PREMATURE  SENILITY  83 

vaso-dilator  nerves  have  the  opposite  effect.  The 
arteries  have  three  functions.  First,  by  means  of 
their  elasticity,  to  store  up  the  energy  excited  by  the 
left  ventricle  during  its  systole  or  contraction,  and 
to  expend  this  again  in  keeping  up  the  flow  of  blood 
during  the  diastole,  when,  in  the  healthy  heart,  the 
ventricle  is  completely  shut  off  from  the  aorta  by 
the  sigmoid  valves.  The  second  function  is  to  reg- 
ulate the  flow  of  blood  to  those  parts  which  need 
it,  by  those  vessels  which  supply  the  acting  organs 
dilating,  while  those  of  the  other  parts  of  the  body 
contract.  The  third  function,  which  is  less  gener- 
ally recognized,  is  to  pass  the  blood  on  from  the 
arteries  into  the  veins  by  peristaltic  action,  an  action 
which  causes  the  arteries  to  be  empty  after  death." 
This  description  may  be  rather  difficult  for  a  lay 
mind  to  thoroughly  appreciate,  but  it  will  at  any 
rate  show  the  main  working  principle  of  the  circula- 
tion. Sir  Lauder  Brunton  again  describes  arterio- 
sclerosis thus:  "Diffuse  or  general  arterio-sclerosis 
is  a  condition  in  which  the  walls  of  the  arteries  be- 
come thickened  by  a  deposit  of  hyaline  tissue  be- 
tween the  muscular  and  endothelial  coats.  This 
deposit,  which  is  so  liable  to  occur  in  kidney  disease, 
is  of  great  importance  because  a  lessening  of  the 
lumen  or  calibre  of  the  arterioles  increases  the  peri- 


84       ROAD  TO  A  HEALTHY  OLD  AGE 

jpheral  resistance,  leads  to  hypertrophy  of  the  heart, 
and  thus  to  an  enormous  increase  of  blood-pressure, 
with  consequent  danger  of  rupture  of  blood-vessels 
and  apoplexy." 

With  this  knowledge  in  our  minds  it  must  be 
evident  that  the  perfection  of  physical  life  depends 
on  the  structural  perfection  and  on  the  physiological 
well-being  of  the  heart  and  of  the  bloodvessels. 
The  blood  is  not  the  life  and  the  heart  is  not 
the  life — the  secret  of  this  mystery  lies  far 
deeper — but  both  are  life's  indispensable  minis- 
ters. 

Hitherto,  perhaps,  our  voyage  through  life  has 
been  a  smooth  and  easy  one,  possibly  too  easy:  a 
fair  wind  has  kept  our  sails  comfortably  filled;  but 
for  many  of  us,  at  about  a  certain  age,  the  weather 
changes,  the  wind  blows  first  on  one  beam,  then  on 
the  other,  or  sometimes  draws  dead  ahead,  and  we 
have  to  keep  trimming  our  sails  or  making  weari- 
some tacks  to  windward.  These  signs  should  be  a 
warning  to  us  that  the  voyage  is  no  longer  going  to 
be  so  easy  as  in  the  past,  and  the  wiser  ones  will 
take  careful  stock  of  themselves.  It  is  now  that  a 
good  physician  will  be  able  to  give  help  that  is 
literally  invaluable,  not  so  much  by  medicines  as  by 
advice.     Let  us  try  and  find  out  for  ourselves  in- 


PREMATURE  SENILITY  85 

dividually  what  are  the  causes  of  this  threatening 
breakdown  and  premature  decay. 

The  first  cause,  but  not  the  most  frequent  one, 
is,  I  think,  hereditary  gout  and  an  hereditary  ten- 
dency to  Bright's  disease,  if  they  can  be  separated, 
but  both  these  tendencies  can  be  kept  well  in  check 
by  a  wise  regime.  The  second  cause,  which  comes 
into  action  far  more  frequently,  is  external  and  is 
to  a  large  extent  preventable  or  removable.  It  is 
the  speed,  the  intensity  and  high  pressure  of  modern 
life,  and  this  not  only  in  business  and  professional 
men,  but  in  the  men  and  women  of  society.  In  the 
latter  class  late  hours,  overfeeding,  overdrinking,  ' 
oversmoking,  and  continual  excitement,  are  to 
blame.  Among  business  men  anxiety  and  the  ex- 
citement of  speculation  are  the  chief  factors. 

We  know  that  among  the  educated  classes  at  any 
rate  actual  drunkenness  has  very  much  lessened, 
but  the  men  and  women  who  lead  these  intense 
lives  have  more  often  than  not  to  keep  themselves 
going  with  some  form  of  stimulant:  with  small 
doses  of  alcohol,  the  small  whisky-and-soda,  the 
liqueur,  etc. ;  others  fly  to  tea  or  strong  coffee  and 
take  them  to  excess.  And  some,  men  and  women 
both,  are  never  happy  and  think  they  can  do  nothing 
without  the  eternal  cigarette,  that  pernicious  form 


86      ROAD  TO  A  HEALTHY  OLD  AGE 

of  smoking,  in  which  one  never  knows  when  one 
has  had  enough. 

The  still  more  disastrous  effects  of  morphia  and 
cocaine  must  be  mentioned,  but  they  are  outside 
the  scope  of  this  work. 

All  these  things  are  without  doubt  temporary 
helps;  as  men  say,  they  clear  the  brain  and  help 
them  to  think  more  clearly  for  the  time,  and  to 
make  another  spurt.  In  great  moderation  and  in 
certain  circumstances  they  are  legitimate  helps  and 
may  carry  us  through  some  crisis;  but  how  do  they 
do  this  ?  One  and  all  by  whipping  up  the  heart  and 
by  increasing  the  rapidity  of  the  circulation,  so  that 
more  blood  is  poured  through  the  brain.  This, 
again  I  say,  may  be  a  legitimate  action  for  a  reason- 
able cause  and  under  exceptional  circumstances. 
But  if  the  brain  is  already  tired,  this  whipping  up 
can  only  end  in  still  greater  fatigue  and  exhaustion, 
and  it  is  thus  that  a  vicious  circle  of  over-excite- 
ment, overwork,  and  over-stimulation  is  set  up. 
The  brain  itself  no  doubt  suffers,  but  not  appreci- 
ably for  some  time.  What  is  first  evident  to  the 
physician  is  the  injury  done  to  the  heart  and  blood- 
vessels. In  a  normal  state  the  heart  is  a  very  busy 
organ.  It  has  to  contract  and  dilate  about  seventy 
times  a  minute,  and  that  whether  we  sleep  or  wake. 


PREMATURE  SENILITY  87 

Sir  Lauder  Brunton,  in  his  "  Therapeutics  of  the 
Circulation,"  says :  ''  We  are  sometimes  accustomed 
to  speak  of  this  *  unresting  organ,'  but  this  is  a  total 
mistake.  The  heart,  in  an  adult  rests  more  than 
thirteen  hours  out  of  the  twenty-four,  the  time  of 
rest  being  the  diastole,  and  the  time  of  work  being 
the  systole  or  contraction.  We  may  say,  then,  that 
the  heart  practically  sleeps  more  than  the  brain  or 
body;  but  the  great  distinction  between  the  sleep  of 
the  heart  and  that  of  the  brain  is  that  the  sleep  is 
for  so  short  a  time.  There  are  very  few  healthy 
men  who  could  not  walk  a  thousand  miles  in  six 
weeks,  walking  a  little  over  eight  hours  a  day  and 
resting  for  the  remainder  of  the  period;  but  there 
are  not  many  men  who  can  emulate  the  feat  of 
Captain  Barclay,  of  walking  a  thousand  miles  in  a 
thousand  consecutive  hours,  because  the  frequent  in- 
terruptions to  their  sleep  would  exhaust  them  com- 
pletely. 

"  In  the  same  way,  when  the  heart  is  forced  to 
beat  more  quickly  than  normal,  it  becomes  more 
and  more  quickly  exhausted  the  higher  the  pulse- 
rate  rises,  because  nearly  the  whole  time  for  the 
extra  work  is  taken  from  the  diastolic  pauses,  from 
the  resting  or  sleeping  time  of  the  heart." 

This  extract  will  clearly  show  how  conservative 


88       ROAD  TO  A  HEALTHY  OLD  AGE 

and  careful  we  should  fee  in  the  expenditure  of  the 
heart's  force.  Fortunately  for  us,  it  is  a  most 
long-suffering  organ,  and  has  a  marvellous  power 
of  adjusting  itself  to  meet  altered  circumstances 
and  strains ;  and  besides  this,  the  natural  heart  under 
ordinary  conditions  is  working  only  at  a  part  of  its 
power  and  there  exists  always  a  considerable  re- 
serve of  latent  force.  This  varies,  of  course,  in 
different  individuals,  and  in  them  under  different 
circumstances.  It  is  this  latent  force  that  enables 
us  in  health  to  make  unusual  and  prolonged  physical 
effort,  and  it  is  the  steady  development  of  this  force 
that  gets  a  man  into  what  we  call  training  and  condi- 
tion. But  as  we  pass  our  zenith  the  power  of  read- 
justment to  varying  strains  and  circumstances,  and 
also  the  latent  force,  become  gradually  less.  A 
sharp  run  or  a  climb  that  we  could  do  easily  at  forty- 
five  suddenly,  it  seems,  becomes  a  big  effort  that 
leaves  us  pumped.  No  doubt  the  change  has  been 
gradually  coming  on,  but  we  have  not  been  tested. 
This  change  may  be  in  the  heart  muscle  or  in  the 
arteries — more  often,  probably,  it  begins  in  the 
arteries.  When  these  symptoms  occur  we  ought 
to  deeply  consider  them  and  profit  by  them.  It  is 
now  that  we  should  get  our  hearts,  our  arteries,  and 
especially  our  blood-pressure,  tested;  now  is  the 


PREMATURE  SENILITY  89 

chance  for  our  physical  salvation.  A  man  may  have 
to  reconstruct  or  rearrange  his  whole  life;  this  to  a 
busy  man  is  often  a  very  difficult  matter,  but  he 
must  ask  himself  these  questions :  Shall  I  go  on  as 
I  am  doing,  do  a  few  more  years'  work  and  then 
die  or  become  a  wreck,  with  a  miserable  old  age? 
Or  shall  I  pull  myself  together,  get  out  of  my  un- 
healthy ruts,  and  lead  a  wise  and  reformed  life, 
with  a  reasonable  hope  of  living  to  a  good  age,  free 
from  paralysis  and  disease  ?  Many  of  us,  perhaps, 
shirk  such  disagreeable  questions,  put  the  answer  off 
to  another  day,  or  say  to  ourselves,  "  As  likely  as 
not  the  doctor  is  all  wrong."  But  at  any  rate  it  is 
our  clear  duty  as  physicians  to  put  the  facts  plainly 
before  such  patients  and  to  advise  them  as  strongly 
as  we  can.    The  choice  of  roads  rests  with  them. 

To  the  general  practitioner  it  is  a  very  important 
thing  to  keep  his  patients  who  are  approaching  old 
age  in  good  health  and  to  prolong  their  lives  as 
far  as  possible.  It  should  not  only  be  his  interest 
to  do  this,  but  also  his  delight ;  for  one's  old  patients 
are  often  one's  best  friends.  Too  many  of  us  get 
into  the  way  of  looking  on  arterio-sclerosis  as  in- 
curable and  unmanageable,  but  this  is  a  great  mis- 
take. The  successful  treatment  of  it  is  a  com- 
plicated problem,  no  doubt,  but  that  should  not  deter 


90      ROAD  TO  A  HEALTHY  OLD  AGE 

us;  it  should  rather  be  an  attraction  to  a  scientific 
mind.  The  writings  of  some  of  our  best  men — Sir 
Lauder  Brunton,  Sir  Clifford  Allbutt,  and  Dr. 
George  Oliver — have  thrown  so  much  light  on  the 
subject  that  there  is  no  longer  any  excuse  for  ignor- 
ance or  apathy  on  our  part. 

It  is  not  the  hard  body  worker,  as  a  rule,  not  the 
man  who  lives  an  outdoor,  athletic  life,  that  de- 
velops arterio-sclerosis,  but  the  anxious,  careworn 
brain  worker,  the  man  who  works  chiefly  indoors 
and  who  oftentimes  takes  his  work  and  his  worries 
home  with  him  and  to  bed  with  him.  For  such  a 
man  there  can  seldom  be  any  real  rest  or  freedom 
from  the  sense  of  strain.  His  sleep  is  rarely  the 
sound,  restoring  unconsciousness  that  the  body 
worker  gets.  The  physiological  result  of  such  a  life 
must  be,  in  the  first  place,  fatigue,  exhaustion,  and 
general  impairment  of  vital  -energy,  but  (in  the 
second  place  hypertrophy  of  the  overused  parts  of 
the  body,  and  these  parts  are  chiefly  the  heart  and 
the  arteries.  The  athlete  may  call  on  his  heart 
and  bloodvessels  to  do  much  abnormal  work,  but 
it  is  only  for  a  sudden  and  a  short  time,  and  the 
intervals  of  rest  are  long  and  sufficient  for  restora- 
tion ;  but  the  man  I  am  describing  is  the  bow  always 
bent.    "Nee  semper  arcum  tendit  Apollo  '*  is  a  prov- 


PREMATURE  SENILITY  91 

erb  he  constantly  ignores.  The  activity  of  his 
mind  is  making  demands  on  his  circulation  night 
and  day,  and  the  vaso-motor  nerves  that  govern  the 
blood-supply  to  his  brain  have  no  rest  from  toil. 
The  hunting,  shooting,  golfing  outdoor  man  may 
and  often  does  lead  an  injudicious,  rather  self- 
indulgent  life,  eating  and  drinking  more  than  is 
necessary,  or  than  is  good  for  him,  but  he  rarely 
gets  sclerosis. 

Dr.  George  Oliver,  in  his  studies  on  "  Blood- 
Pressure,"  says:  "Nervous  anxious  temperaments 
and  occupations  which  involve  much  anxiety,  worry, 
and  nerve  strain  tend  to  produce  somewhat  higher 
levels  of  arterial  pressure,  especially  in  the  latter 
half  of  life.  On  the  other  hand,  placid  tempera- 
ments and  routine  occupations — especially  of  the 
physical  order — dispose  to  the  lower  degrees  of 
pressure.  I  have  observed  that,  as  a  rule,  in  sub- 
jects in  good  condition  and  training,  such  as  ath- 
letes, the  actual  pressure  is  certainly  not  raised, 
and  is,  indeed,  very  often  below  the  average  normal 
point,  a  fact  which  shows  the  importance  of  main- 
taining the  functional  activity  of  the  peripheral  cir- 
culation by  exercise.  And  this  conclusion  is  sup- 
ported by  the  observation  that  in  those  normal  sub- 
jects who  follow  sedentary  indoor  occupations  for 


92       ROAD  TO  A  HEALTHY  OLD  AGE 

many  hours  daily,  the  pressure,  though  generally 
normal,  is  more  frequently  above  than  below  the 
mean  normal  pressure  line." 

Hypertrophy,  or  overgrowth  of  muscles  that  are 
in  special  demand,  seems  to  be  a  physiological  law 
in  health,  and  is  a  law  that  makes  for  efficiency; 
for  instance,  the  blacksmith's  biceps  and  the  boxer's 
shoulder  muscles.  If  these  muscles  did  not  increase 
and  respond  to  the  call  made  on  them,  the  particular 
work  could  not  be  effectually  done;  and  so  in  the 
diseased  condition  we  call  arterio-sclerosis  the 
thickening  and  increased  growth  of  the  heart  muscle 
and  of  the  muscular  coats  of  the  arteries  is,  in  the 
first  place,  a  natural  and  conservative  effort  to  meet 
increased  demands.  But  then  we  come  into  dealings 
with  another  law  of  nature,  which  ordains  that  an 
abnormally  developed  muscle  is  much  more  prone 
to  degeneration  than  a  normal  one.  It  does  not 
matter  if,  when  his  life's  work  is  done,  a  black- 
smith's biceps  shrinks,  and  degenerates,  but  it  mat- 
ters a  good  deal  if  our  hearts  and  arteries  degene- 
rate. And  it  is  this  degeneration  and  failure  that 
is  the  essence  of  the  disease  I  am  trying  to  de- 
scribe. 

Briefly,  then,  the  chain  of  events  is  this — over- 
work, overdemand,  overgrowth,  which  is  sufficient 


PREMATURE  SENILITY  93 

and  effectual   for  a  time,  and  then,   if  the  over- 
demand  persists,  degeneration  and  disease. 

Biedl,  in  his  work  on  the  internal  secretory  or- 
gans, says :  *'  Every  increase  in  normal  activity, 
whether  this  be  an  improved  secretion,  a  strong 
muscular  action,  or  any  other  augmented  perform- 
ance, is  always  associated  with  an  increased  disas- 
similation  which  is  the  work  of  a  disassimilatory 
hormone.  But  it  must  be  remembered  that  in  the 
organism,  as  elsewhere,  no  work  can  be  performed 
without  expenditure.  So  long  as  the  metabolic 
equilibrium  is  maintained,  every  decomposition 
must  inevitably  be  succeeded  by  a  regeneration. 
Even  in  the  case  of  hyper-activity,  so  long  as  ex- 
haustion does  not  supervene,  there  will  be  a  continual 
regeneration  of  the  living  substance,  and  therewith 
a  restitution  of  provision  for  labor.  With  the  ces- 
sation of  the  disassimilatory  stimulus  assimilation 
becomes  excessive,  and  if  the  process  is  frequently 
repeated,  the  well-known  phenomena  of  organic 
hypertrophy  will  make  their  appearance."  ^^,,,„«.,*—  \ 

Such  is  the  scientific  explanation  of  hypertrophy. 
But  we  see  the  same  laws  working  in  national  and 
political  life.  The  hypertrophy,  the  overgrowth  of 
militarism  run  riot;  a  thing  in  moderation  not  bad 
in  itself,  which,  indeed,  will  often  include  and  de- 


94       ROAD  TO  A  HEALTHY  OLD  AGE 

velop  such  virtues  as  discipline,  self-denial,  and 
patriotism,  becomes  a  great  and  dangerous  evil.  Its 
inevitable  consequences,  the  lust  of  power,  of 
wealth  and  conquest,  lead  surely  to  a  deterioration 
or  degeneration  of  the  whole  moral  and  religious 
tone  of  a  nation.  All  Gk^d's  laws  are  made  for  our 
use.  It  is  little  to  our  honor  that  we  defeat  them 
by  our  misuse. 

There  can  be  no  doubt,  I  think,  that  there  is  a 
stage — probably  lasting  for  two  or  three  years— -of 
almost  constantly  but  slightly  raised  arterial  tension 
or  pressure  before  any  real  sclerosis  or  thickening 
takes  place,  and  it  is  in  this  stage,  of  course,  that 
we  can  do  so  much  for  our  patients  and  that  patients 
can  do  so  much  for  themselves;  they  should  learn 
how  to  rearrange  their  lives  and  habits  and  so  to 
avoid  the  grave  symptoms  and  dangers  that  must 
otherwise  ensue.  Dr.  Oliver  says  on  this  point: 
"  In  diffuse  arterio-sclerosis  the  accessible  arteries 
may  not  be  appreciably  thickened,  especially  in  the 
earlier  stages  of  the  disease,  and  yet  the  arterial 
pressure  may  be  raised  persistently  and  definitely. 
It  would  seem  as  if  the  disease  begins  more  particu- 
larly in  the  terminal  divisions  of  the  arterial  sys- 
tem— splanchnic  and  systemic,  especially  splanchnic. 
In  this  stage  the  peripheral  resistance  is  apparently 


PREMATURE  SENILITY  95 

due  mainly  to  muscular  contraction  in  the  arterioles ; 
for  these  respond  readily  to  vaso-dilator  remedies, 
and  the  increase  of  arterial  pressure,  which  is  not 
so  high  as  it  subsequently  becomes,  quickly  subsides 
after  each  dose.  In  this  hypertonic  stage  (the  stage 
of  presclerosis  described  by  Houchard)  the  diastolic 
pressure  rarely  rises  above  120  mm.  and  is  often 
only  no  mm.,  and  the  systolic  pressure  does  not, 
as  a  rule,  exceed  160  mm.  and  is  frequently  only 
145  mm.  or  150  mm.,  and  the  arteriometer  also 
demonstrates  the  contraction  of  the  radial  calibre 
and  the  favorable  effect  of  the  treatment  in  dilat- 
ing it.  But  as  the  disease  advances  organic  changes 
in  the  arterial  wall  develop,  when  vaso-dilators  only 
partially  relieve  the  pressure,  and  when  they  may 
ultimately  fail  to  lower  it  at  all.  In  this  stage  the 
accessible  arteries,  such  as  the  brachial,  become 
thickened  and  the  arterial  pressure  rises  consider- 
ably; the  systolic  armlet  reading  advances  to  such 
high  figures  as  200  to  260  mm."  We  may  take  it, 
then,  that  a  small  but  persistent  rise  of  tension  is 
the  first  objective  symptom  that  we  can  discover  in 
threatening  sclerosis;  the  objective  heart  symptoms 
belong  to  a  later  stage;  but  there  are  subjective 
symptoms  that  should  be  a  warning,  and  frequently 
it  is  these  symptoms  that  bring  the  patient  for  medi- 


96       ROAD  TO  A  HEALTHY  OLD  AGE 

cal  help ;  they  are  chiefly  an  increasing  shortness  of 
breath  on  exertion,  uncomfortable  feelings  about  the 
head,  such  as  giddiness  and  singing  in  the  ears, 
especially  on  stooping,  and  more  particularly,  per- 
haps, a  constant  sense  of  fatigue  that  is  quite  out  of 
proportion  to  the  work  that  has  been  done.  This  is 
one  type  of  case,  but  there  is  another  type  that  often 
eludes  the  physician  and  deludes  the  patient.  A  full- 
blooded,  sanguine  man  of  fifty  to  sixty  has  without 
knowing  it  persistent  high  tension;  he  feels  at  the 
top  of  his  form,  and  lives  at  the  top  of  his  form ;  his 
output  of  energy  and  work  is  large  and  good,  and  to 
all  appearances  his  end  is  not  yet;  he  reminds  one 
rather  of  the  men  in  the  73rd  Psalm  who  "  are  in 
no  peril  of  death,  but  are  lusty  and  strong;  they 
come  into  no  misfortune  like  other  folk,  neither  are 
they  plagued  like  other  men."  It  is  an  undoubted 
fact  that  high  arterial  pressure  in  some  men  leads  to 
increased  energy  and  efficiency,  at  any  rate  for  a 
time,  but  the  breakdown  comes  very  suddenly,  and 
their  day's  work  is  done.  Unconsciously  they  walk 
in  slippery  places,  and  their  precarious  foothold  on 
the  mountain  of  life  is  often  only  discovered  by 
some  accident,  such  as  an  attack  of  gout  or  an 
examination  for  life  insurance.  If  such  discovery 
should  be  their  good-fortune,  they  may  find  safety. 


PREMATURE  SENILITY  97 

but  only  by  a  revision  of  their  lives,  by  much  self- 
denial,  and  by  a  sensible  humility. 

As  practical  physician^s,_thenj  our  aim  must  be  to 
get  hold  of  our  patients  in  this  presclerotic  stage  of 
hypertonus,  and  to  wisely  anticipate  and  prevent  the 
development  of  the  serious  organic  changes  that 
belong  to  the  later  stages  of  the  disease. 

Anyone  who  lives  to  sixty  years  without  a  rise  of 
tension,  and  who  has  a  sound  heart,  is  likely  to  live 
to  a  full  old  age,  but  anyone  who  between  fifty  and 
fifty-five  develops  raised  arterial  tension  is  not  likely 
to  live  anything  like  the  full  span,  unless  he  take 
himself  seriously  in  hand.  His  life,  his  work,  and 
all  his  habits,  must  be  carefully  considered  and 
arranged,  and  he  should  certainly  place  himself 
under  his  physician's  care.  The  proverb  that  says 
*'  A  man  is  as  old  as  his  arteries  "  should  be  con- 
sidered no  longer  a  proverb,  but  a  working  prin- 
ciple. 

Hitherto  I  have  considered  overwork  and  over- 
stimulation, with  their  inseparable  ally,  want  of  rest, 
as  the  chief  causes  of  the  heart  and  vascular  changes, 
but  there  is  certainly  another  and  most  important 
agency  at  work  also,  and  that  is  the  absorption  from  f\^ 
the  stomach  and  the  bowels  of  poisons,  the  result  ^'^   / 


of  imperfectly  digested  food. 


98       ROAD  TO  A  HEALTHY  OLD  AGE 

We  all  know  the  serious,  even  the  sometimes  fatal, 
results  of  ptomaine-poisoning.  That,  in  a  minor 
degree,  is  going  on  all  the  time  with  some  people, 
and  probably  there  is  also  chronic  poisoning  from 
morbid  bacteria  in  the  intestines  or  from  normal  bac- 
teria in  excessive  numbers.  What  is  known  as  the 
bacterial  flora  of  the  intestines  has  a  marvellous 
capacity  for  extravagant  growth.  It  is  all  very  well 
for  us  to  blame  these  wicked  microbes  "  dans  le 
pays  bas  '*;  just  now  they  are  made  to  be  the  uni- 
versal scapegoats,  but  it  is  largely  our  own  habits 
that  are  at  fault.  It  is  not  so  much  that  we  are 
"  gluttonous  men  and  winebibbers,"  but  that  we  eat 
and  drink  richer  and  more  stimulating  food  than 
we  need.  And  we  rarely  give  ourselves  time  for 
perfect  digestion.  Either  from  eating  too  much,  or 
from  hurrying  away  from  our  food  into  some  new 
work  or  excitement,  our  stomachs  seldom  get  that 
physiological  rest  and  sleep  that  is  so  necessary  to 
perfect  digestion.  Our  whole  digestive  apparatus 
becomes  a  fertile  field  for  poisonous  weeds,  a  seeth- 
ing caldron  of  discontent.  That  arterial  disease  can 
be  produced  by  this  absorption  is  proved,  I  think, 
partly  by  the  results  of  a  reformed  diet  and  life  and 
partly  by  the  results  of  treatment  of  the  digestive 
errors.     Without  any  other  direct  treatment,  we 


PREMATURE  SENILITY  99 

often  see  the  tension  come  down  and  the  symptoms 
pass  away.  Another  collateral  proof  is  seen  also 
in  chronic  bronchial  asthma.  In  this  disease  after  a 
time  there  is  always  a  great  growth  of  morbid 
bacteria  in  the  bronchial  tubes — pneumococci, 
streptococci,  or  staphylococci — and  they,  of  course, 
get  absorbed  into  the  general  system.  It  is  very 
common  to  find  in  this  condition  arterial  tension 
raised  to  a  considerable  degree.  If  we  cure  that 
bronchial  affection  and  destroy  the  morbid  bacteria 
by  a  wise  vaccine  treatment,  we  shall  see  the  raised 
tension  come  down  to  the  normal,  and  all  its  other 
symptoms  disappear.  I  shall  go  more  thoroughly 
into  food  questions  in  the  next  chapter. 

Before  approaching  the  more  direct  treatment  of 
the  disease  it  will  be  wise  to  gain  a  clear  and 
accurate  conception  of  its  arterial  condition  and 
pathology,  and  of  the  relative  importance  of  the 
abnormalities  one  may  find.  To  do  this  one  must 
study  carefully  the  literature  of  the  subject.  I 
would  mention  two  small  and  inexpensive  books, 
whose  authorship  is  their  own  guarantee :  "  Studies 
in  Blood-Pressure,*'  by  Dr.  George  Oliver  (H.  K. 
Lewis),  "Therapeutics  of  the  Circulation,"  by  Sir 
Lauder  Brunton  (John  Murray) ;  and  a  newer  and 
larger  work  is  "  Diseases  of  the  Arteries,"  by  Sir 


100  ROAD  TO  A  HEALTHY  OLD  AGE 

Clifford  Allbutt.  From  these  clear  and  reliable 
works  the  busy  practitioner  will  soon  get  a  good 
working  acquaintance  with  the  subject.  The  estima- 
tion and  significance  of  systolic  and  diastolic  blood- 
pressure  and  the  use  of  the  sphygmograph  and 
sphymomanometer  are  all  amply  explained.  It  is 
hardly  necessary  to  say  that  the  use  of  the  ma- 
nometer in  arterio-sclerosis  is  absolutely  essen- 
tial. 

If  a  patient  come  to  us  in  the  presclerotic  stage, 
when  the  tension  is  raised  and  when  there  are  the 
uncomfortable  head  symptoms  that  I  have  before 
described,  but  when  there  are  no  real  organic 
changes  to  be  discovered  in  heart  or  kidneys,  what 
can  we  do?  Firstly,  much  can  be  done  by  compara- 
tive rest,  by  early  hours  and  long  nights  (the  arterial 
tension  after  a  good  night's  rest  is  often  lo  mm. 
below  the  average  day's  pressure),  by  cutting  down 
extremes  of  work  or  social  pleasures,  and  by  the 
avoidance  of  excitement  and  over-stimulation.  A 
complete  rest  from  business  and  change  of  scene 
when  practicable  are  very  useful  also.  The  diet 
should  be  plain  and  simple ;  red  meat  should  be  eaten 
in  great  moderation  and  not  more  than  once  a  day. 
There  is,  as  a  rule,  no  need  for  an  absolute  purin- 
f  ree  diet,  but  it  should  be  in  that  direction.    It  will 


PREMATURE  SENILITY  loi 

be  well,  perhaps,  to  give  here  the  purin  contents  of 
foods  in  grains  per  pound,  pint,  or  teacup: 

Sweetbread  70.43     Halibut 7.14 

Liver    19.26     plaice   5.56 

Beef  Steak  14.45     Cod   4.07 

Sirloin    9.13     ^eans    4.16 

Chicken    9.06     Lentils    4.16 

Loin  of  Pork 8.48      Oatmeal  3.45 

Veal    8.13     Coffee    1.70 

Ham   8.08      Ceylon  tea 1.21 

Mutton 6.75     China  tea 0.75 

Salmon   8.15 

(Potts,  Lancet,  1906,  Vol.  II.,  p.  933.) 

Perhaps  the  chief  thing  is  to  avoid  the  flesh* 
extracts,  such  as  beef -tea,  strong  meat  soups,  and 
rich  gravies ;  for  this  reason  boiled  or  stewed  meats 
are  better  than  fried  or  roast.  This  applies  to  fish 
and  chicken  also;  a  plain  grill  is  good,  but  the 
frying-pan  is  a  danger.  Vegetable  soups  made  with 
a  bone  stock  may  be  taken.  Cheese,  eggs,  and  milk 
should  supply  the  greater  part  of  the  nitrogenous 
food.  The  better  sorts  of  vegetable  foods,  such  as 
oatmeal,  lentils,  peas,  and  nuts,  will  all  help  to  take 
the  place  of  albuminous  animal  foods.  A  certain 
amount  of  fat  should,  always  be  taken.  A  fish  and 
chicken  diet  contains  too  little  fat,  and  should  be 
perfected  by  bacon,  hot  or  cold.  All  the  farinaceous 
foods  are  good,  but  the  more  starchy  ones,  such  as 


102   ROAD  TO  A  HEALTHY  OLD  AGE 

sago,  rice,  and  cornflour,  are  with  some  peo^lejiiore 
liable  to  cause  fermentative  dyspepsia.  Of  equal 
importance  as  the  quality  of  the  food  is  the  quantity. 
We  most  of  us  take  more  food  than  we  really  need, 
and  more  than  we  can  easily  dispose  of.  This  is 
especially  the  case  as  our  strength  and  vitality 
lessen ;  the  whipping  up  of  the  tired  horse  helps  little 
towards  the  journey's  end.  Coffee  is  a  good  stimu- 
lant, especially  as  cafe  au  lait  for  breakfast,  but 
strong  black  coffee  taken  after  lunch  or  dinner  is 
certainly  a  raiser  of  tension.  Tea,  as  far  as  we 
know,  has  not  the  same  effect  on  the  arteries,  but 
taken  in  excess  or  too  strong  may  cause  an  over- 
worked heart  to  get  irregular  and  feeble.  Good 
China  tea  seems  to  have  less  of  this  bad  effect  than 
other  growths,  but  is  not  quite  such  an  effective 
stimulant.  Sugar  in  moderate  quantities,  especially 
cane-sugar,  certainly  helps  the  heart  to  do  its  work, 
and  is  a  fuel  and  especially  a  muscle  food.  This  is 
well  recognized  in  the  feeding  of  our  soldiers  on 
long  marches.  With  regard  to  alcohol,  one  must 
say  that  the  majority  of  such  patients  are  better 
without  it,  but  when  a  person  has  been  accustomed 
to  a  moderate  amount,  taken  with  his  food,  it  does 
not  always  do  to  stop  it.  Alcohol  is  not  a  tension- 
raiser,  as  many  seem  to  think,  but  has  rather  the 


PREMATURE  SENILITY  103 

opposite  action,  and  if  stopped  suddenly  the  power 
of  digestion  may  be  lessened  and  the  whole  tone 
of  the  body  depressed. 

So  many  people  in  this  presclerotic  stage  have 
gouty  tendencies  that  strong  wines  and  liquors  are 
certainly  unsuitable ;  a  little  light  wine,  such  as  claret, 
still  Moselle,  or  Grave,  may  do  no  harm  if  taken 
with  the  meals  only;  the  same  rule  applies  also  to 
small  quantities  of  well-matured  spirits.  Alcohol, 
wisely  chosen  and  only  used  as  a  digestive  tonic, 
may  help,  but  when  used  as  a  frequent  stimulant  to 
enable  the  body  or  mind  to  do  more  work,  or  to 
increase  endurance  for  pleasure,  it  certainly  does 
harm.  The  Americans  have  a  proverb  which  con- 
tains a  good  deal  of  truth,  "  It  is  not  the  drinks  that 
do  the  harm,  but  the  drinks  between  the  drinks." 

Sir  Lauder  Brunton  says :  "  All  the  alcohols  tend 
to  dilate  vessels,  to  lessen  blood-pressure,  and  ulti- 
mately to  diminish  activity  of  the  nervous  tissues, 
although  at  first  they  may  seem  to  have  a  stimulant 
action."  In  another  place  he  says :  "  Alcohol  pro- 
duces dilation  of  the  peripheral  vessels  and  tends  to 
lower  blood-pressure,  while  at  the  same  time  it 
stimulates  the  heart."  Alcohol  contains  so  little 
nutritious  food  (with  the  exception  of  the  sugars 
and  extractives  of  wines  and  beers)  that  in  itself  it 


104  ROAD  TO  A  HEALTHY  OLD  AGE 

may  be  said  to  give  nothing  to  the  body;  it  only 
enables  a  man  to  draw  on  his  reserves.  This  may 
be  very  useful  in  emergencies — and  of  course  is  so 
' — or  when  used  in  great  moderation,  but  unless 
great  care  is  taken,  its  inevitable  tendency  must 
be  to  exhaust  the  reservoirs  of  nervous  energy.  The 
deleterious  effect  on  the  other  organs  when  taken  in 
excess  is  well  known,  but  is  outside  the  scope  of  this 
article.  This  question  of  the  use  of  alcohol  must 
be  argued  and  handled  by  physicians  on  a  thor- 
oughly scientific  basis.  We  shall  do  more  for  the 
cause  of  temperance  by  sober  judgment  and  advice 
founded  on  scientific  fact  than  by  hot-headed,  pre- 
judiced generalizations.  For  a  wise  scientific  and 
temperate  article  on  this  subject  I  would  advise  my 
readers  to  study  Sir  Lauder  Brunton's  "  Mono- 
graph on  Alcohol :  What  it  Does  and  What  we 
Ought  to  Do  with  it,"  issued  by  The  True  Temper- 
ance Association,  Caxton  House,  Westminster. 

The  question  of  tobacco  is  very  often  presented 
to  us,  and  it  is  not  always  an  easy  one  to  answer. 
Nicotine,  no  doubt,  is  one  of  the  most  powerful 
raisers  of  arterial  tension  known,  but  in  ordinary 
forms  of  smoking  not  very  much  gets  into  the  sys- 
tem. Tobacco-chewing  and  snuff-taking — both  of 
which  are  happily  nearly  extinct — probably  intro- 


PREMATURE  SENILITY  105 

duce  more  nicotine  into  the  body  than  any  form  of 
smoking.  With  cigars  the  combustion  is  so  complete 
that  very  little  of  the  poisonous  parts  of  the  plant 
remains;  rather  more  remains  in  pipe-smoking.  In 
cigarette-smoking  the  combustion  is  nearly  as  com- 
plete as  with  cigars,  but  an  ordinary  cigarette 
smoker  uses  much  more  tobacco  in  the  course  of  a 
day  than  a  cigar  smoker,  for  he  seldom  arrives  at 
the  satisfaction  point.  The  habit  of  inhaling  cigar- 
ette smoke  is,  however,  the  real  danger ;  the  absorp- 
tion of  nicotine  from  the  bronchial  mucous  mem- 
brane is  very  rapid,  and  much  more  is  absorbed  in 
this  way  than  by  those  who  smoke  through  the 
mouth  and  nose  alone.  The  other  chemical  products 
of  tobacco  combustion,  pyridine  and  the  picoline 
bases,  have  probably  their  effects  on  the  vaso-motor 
nerves  also,  but  their  evil  influence  is  chiefly  shown 
by  irritation  of  the  mucous  membrane  of  the 
throat. 

Oliver,  in  his  experiments,  found  that  in  ordinary 
people,  not  excessive  smokers,  tobacco  raises  the  sys- 
tolic pressure  from  10  to  15  mm.,  but  that  it  does  not 
raise  the  diastolic,  so  that  the  variation  between  the 
two  becomes  abnormal;  this  effect  soon  subsides 
after  smoking  is  finished — in  a  quarter  of  an  hour 
or  so. 


io6  ROAD  TO  A  HEALTHY  OLD  AGE 

We  all  know  from  experience  that  excessive  smok- 
ing often  produces  very  rapid  action  of  the  heart, 
with  irregularity  and,  in  some  cases,  even  pretty 
severe  cardiac  pain.  Nicotine,  like  many  other  vege- 
table poisons,  has  two  actions :  first  it  raises  blood- 
pressure,  but  after  long  or  excessive  use  a  rebound 
takes  place  and  the  pressure  falls  far  below  normal, 
and  so  the  ultimate  effect  of  excessive  smoking  is  a 
feeble,  low-tension  pulse,  often  irregular. 

It  is  the  first  pressure-raising  effect  that  clears  the 
brain  and  helps  one,  for  a  time,  to  think  more  rapidly 
and  clearly;  it  is  the  second  that  produces  the  tired- 
ness, the  feebleness,  and  the  absence  of  initiative 
that  we  see  so  often  in  the  man  saturated  with 
tobacco.  It  will  readily  be  seen  that  a  drug  which 
affects  the  circulation  so  strongly  should  be  used 
with  great  caution  and  moderation  in  cases  of  ab- 
normal or  diseased  arteries.  Tobacco,  no  doubt, 
has  somewhat  of  a  soothing  and  quieting  effect  on 
many  people  with  irritable  nerves,  and  to  this  extent 
is  useful,  but  one  cannot  help  coming  to  the  conclu- 
sion that  the  average  man,  with  a  tendency  to 
arterio-sclerosis,  had  better  give  it  up  entirely;  this 
applies  especially  to  men  who  lead  indoor  lives. 
Moderation  in  smoking  is  very  rare  and  difficult  to 
maintain.    The  man  threatened  with  this  disease  has 


PREMATURE  SENILITY  107 

to  face  a  serious  enemy,  and  should  take  no  unneces- 
sary chances. 

It  has  been  shown  that  an  indoor,  sedentary  life 
conduces  to  high  blood-pressure  more  than  an  out- 
door, active  one.  It  follows,  then,  that  we  must  try 
to  reform  our  patients  in  this  matter  also ;  but  when 
we  find  such  a  one  with  his  pressure  much  above  the 
normal,  it  is  very  necessary  to  proceed  slowly.  Till 
the  tension  has  been  reduced  considerably  and  the 
heart  is  able  to  do  its  work  easily,  no  violent  exer- 
cise should  be  taken.  When  the  heart  has  to  force 
the  blood  through  tightened,  narrowed  arteries,  it 
will  be  readily  understood  that  more  force,  more 
vis  a  fergo,  has  to  be  used.  A  mathematician  would 
astonish  one  if,  by  his  calculations,  he  showed  the 
great  increase  of  force  necessary  to  pump  or  force 
fluid  through  tubes  of  diminished  calibre.  Any 
great  exertion  or  strain  under  such  circumstances 
produces  weakening  and  dilation  of  the  heart  itself, 
and  this  not  only  causes  much  discomfort  and  in- 
ability, but  makes  the  recovery  to  be  slower.  Over- 
strain, with  high  tension,  may  cause  even  a  breakage 
of  the  valves  of  the  heart  themselves,  and  so  the 
heart  becomes  a  leaky  pump  as  well  as  an  inefficient 
one.  This  shows  that  the  treatment  of  these  early 
cases  needs  very  careful  watching.     Walking  at  a 


io8      ROAD  TO  A  HEALTHY  OLD  AGE 

moderate  pace,  on  the  flat  at  first,  and  then  up 
graduated  slopes,  is  the  best  exercise  for  most; 
but  they  should  always  stop  short  of  the  pumped 
or  out-of-breath  stage.  Riding  on  horseback,  if 
the  horse  is  not  a  puller,  is  also  very  good.  As  the 
symptoms  improve,  golf  may  be  allowed,  but  not  on 
a  hilly  course,  and  here  the  temptation  to  hurry  on 
to  the  next  hole  must  be  avoided,  and  also  the 
temptation  to  lose  your  temper.  People  with  scler- 
osis cannot  afford  to  indulge  in  temper:  it  is  too 
risky.  Cicero  says :  "  Not  every  sort  of  temper  nor 
every  kind  of  wine  grows  sour  with  age,"  but,  as 
far  as  we  know,  he  was  not  a  golfer.  Cycling  is 
good  if  the  conditions  are  good,  but  riding  uphill 
and  against  a  head  wind  may  very  soon  become  a 
dangerous  strain.  In  all  forms  of  exercise  some 
distraction  or  diversion  of  the  mind  helps  to  a 
better  result,  and  this  is  in  favor  of  games  such  as 
golf  and  lawn-tennis.  Croquet  hardly  comes  under 
the  head  of  exercise,  but  is,  I  suppose,  a  diversion. 
Mountain  air  is  good  for  such  folk,  but  not  at  too 
great  an  altitude.  Above  3,000  or  3,500  feet  the 
alteration  of  barometic  pressure  causes  shortness  of 
breath,  and  at  still  higher  altitudes  a  tendency  to 
haemorrhage.  The  stimulus  of  the  good  air  often 
leads  one  on  to  do  more  than  is  advisable  and  so  to 


PREMATURE  SENILITY  109 

overstrain  the  heart.  With  these  guides  and  reser- 
vations in  our  minds,  the  fact  remains  that  open  air 
and  steady  exercise  are  Nature's  way  of  preventing 
the  degeneration  of  the  body. 

The  medicinal  treatment  of  this  arterial  condi- 
tion, in  the  first  place  of  high  tension  and  in  the 
second  place  of  sclerosis  or  thickening,  is  a  subject 
full  of  interest  and  full,  also,  of  hope.  Till  the 
last  few  years  we  have  been  almost  powerless.  That 
disagreeable  drug,  iodide  of  potassium,  was  almost 
our  only  weapon.  Its  action  was  very  uncertain, 
especially  in  the  early  stage,  and  many  people  could 
not  take  it  on  account  of  its  effect  on  the  stomach 
and  of  its  tendency  to  cause  iodism.  The  first  step 
in  advance  was  the  discovery  of  the  effects  of  the 
nitrite  group — sodium  nitrite,  amyl  nitrite,  etc. 
These  have  a  rapid  action  in  lowering  tension,  and 
are  very  useful  in  emergencies  where  an  immediate 
effect  is  desired ;  but  their  action  is  very  short-lived, 
and  in  some  people  they  cause  troublesome  head- 
ache. Their  action  in  true  angina  pectoris,  espe- 
cially that  of  amyl  nitrite,  is  of  great  value.  The 
comparative  freedom  from  acute  pain  and  the 
lengthened  years  of  life  that  such  sufferers  owe  to 
Lauder  Brunton  and  Murrell  form  a  debt  unpayable. 
Erythrol  tetranitrate  and  mannitol  nitrate  belong  to 


no     ROAD  TO  A  HEALTHY  OLD  AGE 

the  same  group,  but  their  action  is  more  prolonged. 
As  a  groundwork  of  successful  treatment  all  these 
remedies  cannot  be  relied  upon,  for  their  eflfect  is 
never  permanent.  The  real  hope  of  successful 
therapeutics  lies  in  the  organic  animal  remedies. 

A  few  years  ago  Dr.  George  Oliver  of  Harro- 
gate, one  of  our  greatest  pioneers  in  the  study  of 
this  condition  and  in  the  accurate  knowledge  of  all 
that  pertains  to  the  circulation  of  the  blood,  brought 
into  notice  the  good  action  of  the  hippurate  salts 
(this  is  a  true  animal  remedy).  They  have  many 
great  advantages :  their  action  lasts  for  a  long 
time,  they  cause  no  headache  and  no  gastric  disturb- 
ance, and  unless  they  are  pushed  too  far — to  the 
lowering  of  the  blood-pressure  below  the  normal 
point — they  are  not  debilitating. 

The  relief  to  the  heart  and  brain  discomforts  of 
the  early  days  of  high  blood-pressure  is  very  marked. 
Hippuric  acid,  which  can  be  produced  synthetic- 
ally by  treating  glycocol  with  benzoyl  chloride,  is 
I  used  in  the  form  of  its  salts,  the  chief  of  which  are 
I  the  lithium,  the  sodium,  and  the  ammonium  hip- 
'purate.    The  ammonium  salt  is,  I  think,  only  half 
as  strong  in  its  action  as  fhe^ther  two.    If  was  first 
used  as  a  solvent  of  uric  acid,  but  is  now  chiefly 
used  as  a  tension  depressor.    It  is  interesting  to  note 


PREMATURE  SENILITY  in 

that  it  is  excreted  daily  to  the  extent  of  about  J^  to 
I  gramme  in  man  on  a  mixed  diet,  but  that  it  may 
reach  2  to  3  grammes  on  a  vegetarian  diet. 

The  hippurates  and  benzoates  are  closely  related 
chemically,  and  are  very  similar  in  their  action,  but 
the  hippurates  are  the  more  easily  digested.  It  is 
very  rarely  that  5  to  10  grains  daily  of  one  or  other 
of  these  salts  fail  to  reduce  abnormal  blood-pressure 
to  the  normal  point  or  near  it  in  the  early  stages, 
and  the  relief  they  give  to  all  the  uncomfortable  head 
symptoms  and  to  the  feelings  of  heart  distress  is 
very  satisfactory.  I  wish  I  could  give  a  scientific 
explanation  of  this  good  effect.  I  was  in  communi- 
cation with  Dr.  Oliver  on  the  subject,  but  his  un- 
timely death  prevented  his  final  report.  The  lithium 
salt  is  perhaps  the  best  where  there  are  symptoms 
of  gout  or  rheumatism ;  the  ammonium  where  there 
is  debility. 

There  is  still  another  class  of  remedy  which  I 
believe  to  be  still  more  valuable,  especially  in  the 
later  and  more  confirmed  stages  of  the  disease — viz., 
the  extracts  of  some  of  the  ductless  glands,  of  which 
thyroid  is  the  chief.  We  may  roughly  say  that  all 
the  gland  extracts  we  have  at  present  are  tension 
depressors,  with  the  exception  of  the  suprarenal  and 
the  pituitary,  and  in  the  skilful  use  of  these,  either 


112     ROAD  TO  A  HEALTHY  OLD  AGE 

singly  or  in  combination,  we  have  most  powerful 
remedies. 

The  original  experiments  of  Oliver  and  Schafer 
show  the  effects  of  the  thyroid  on  aterial  tension. 
These  are  confirmed  by  Brunton,  who  says :  "  Thy- 
roid gland,  when  taken  by  the  mouth,  dilates  the 
peripheral  vessels,  makes  the  skin  warm  and  moist, 
and  quickens  the  pulse.  In  this  respect  it  antagon- 
izes the  suprarenal  secretions.  Besides  this  effect  on 
the  blood-pressure,  it  has  other  effects  on  the  metabo- 
lism, which  is  important." 

Biedl  says :  "  If  thyroid  extract  or  iodothyrin  be 
given  continually  for  two  or  three  weeks,  the  amount 
of  carbonic  acid  excretion  will  be  increased  by  1 5  to 
25  per  cent.  The  nitrogenous  interchanges  are 
Invariably  disturbed  by  thyroid  extract ;  the  increased 
decomposition  of  albumin  is  expressed  by  an  in- 
creased excretion  of  nitrogen.  (By  increasing  the 
caloric  food-supply  the  nitrogen  losses  may  be 
avoided.)  In  obesity,  owing  to  the  large  reserves 
of  fat,  the  loss  of  albumin  is  not  so  great  as  in  the 
normal  subject. 

"Thyroid  feeding  also  brings  about  a  consider- 
able increase  of  calcium  excreted,  the  calcium  carry- 
ing off  with  it  a  large  proportion  of  phosphorus." 

It  is  very  evident,  then,  that  we  have  in  thyroid 


PREMATURE  SENILITY  113 

medication  something  much  more  than  a  mere  ten- 
sion depressor.  Its  other  properties,  influencing 
the  excretions,  explain  to  some  extent  its  sphere  of 
usefulness,  and  also  its  drawbacks.  The  increased 
excretion  of  calcium  may  be  very  helpful  in  sclero- 
sis, especially,  perhaps,  when  there  is  atheroma; 
the  loss  of  phosphorus  accounts  in  some  measure  for 
the  debility  and  for  the  nervous  symptoms  that  often 
follow  its  use.  The  increased  excretion  of  carbonic 
acid  and  of  nitrogen  are  probably  helpful,  but  all 
these  by-effects  should  be  produced  slowly  and 
cautiously. 

The  loss  of  phosphorus,  which  shows  itself  in 
nervous  depression  and  feebleness,  can  be  met  by 
giving  phosphorus  in  some  form,  and  the  best  form 
is,  I  t^i^k,  J^cithin.  I  have  thought  that  thyroid 
treatment  in  sclerosis  is  more  satisfactory  in  the 
cases  where  there  is  no  serious  kidney  complication ; 
this  seems  reasonable,  for  in  Brighfs  disease  the 
kidneys  would  only  imperfectly  carry  off  the  results 
of  increased  nitrogen  metabolism,  and  this  failure 
of  excretion  would  leave  the  blood  overcharged 
with  these  products.  In  thyroid  treatment  we  must 
stop  short,  as  far  as  possible,  of  producing  its  dis- 
agreeable effects — palpitation  of  the  heart,  giddiness, 
and  their  accompanying  distress ;  the  sphygmomano- 


114  ROAD  TO  A  HEALTHY  OLD  AGE 

meter  should  here  be  our  guide.  If  the  tension  fall 
to  normal  or  below,  and  the  above  symptoms  appear, 
a  5-grain  tablet  of  suprarenal  extract  once  or  twice 
a  day  will  soon  relieve  them.  This  sounds  like  an 
illogical  proceeding  when  you  are  trying  to  lower 
pressure,  but  in  practice  it  succeeds  well.  It  is  a 
well-knowtn  fact  that  in  health  thyroid  feeding 
increases  the  amount  of  adrenine  (the  suprarenal 
secretion)  in  the  blood;  this  is  probably  a  wise  com- 
pensation, and  one  can  readily  understand  how,  in 
diseased  conditions,  this  compensation  may  fail  to 
take  place. 

In  using  these  natural  gland  extracts  as  medicines, 
we  must  not  lose  sight  of  those  important  properties 
which  enable  them  to  act  as  hormones  (stimulants) 
or  chalones  (inhibitors)  to  the  other  glands;  and  in 
imitating  Nature  we  shall  get  the  best  results. 

Though  in  obesity  thyroid  often  causes  loss  of 
weight,  in  thin  people  who  show  signs  of  hypo- 
thyroidism  it   often  has   the   opposite   effect.      In 
r  thyroid  treatment,  especially  as  old  age  draws  near, 
•'we  have  before  us  a  most  interesting  field  of  study, 
full  of  possibilities  and  hope. 

For  many  years  iodide  of  potash  has  had  a  great 
reputation  in  the  treatment  of  arterio-sclerosis,  a 
reputation  far  beyond  its  deserts;  but  it  apparently 


PREMATURE  SENILITY  115 

does  some  good  in  certain  cases.  As  far  as  experi- 
ments go,  it  has  no  direct  effect  in  lowering  blood- 
pressure.  It  almost  certainly  acts,  as  all  preparations 
of  iodine  do,  by  stimulating  and  increasing  the  out- 
put of  thyroid  secretion.  Rendle  Short  says :  "  An 
increased  thyroid  secretion  may  be  obtained  by  giv- 
ing iodides.  There  we  find  the  explanation,  so  long 
sought  in  vain,  of  the  effects  of  iodides  on  gummata, 
arterio-sclerosis,  and  aneurism.  The  beneficial  agent 
is  really  the  increased  internal  secretion  of  the  thy- 
roid gland.  Two  important  results  of  observation 
and  experiment  confirm  this  theory.  In  the  first 
place,  in  cases  of  myxcedema,  arterio-sclerosis  is 
early  and  intense,  and  the  same  is  true  in  animals 
after  removal  of  the  thyroid. 

"  Eiselberg  gives  a  number  of  very  convincing 
photographs  of  intense  atheroma  in  the  aorta  in  his 
cretin  lambs  from  which  the  thyroid  has  been  re- 
moved. In  the  second  place,  thyroid  extract  has  a 
wonderful  power  over  young  connective  tissue,  as  is 
seen  by  the  way  in  which  it  absorbs  the  subcutaneous 
thickening  of  myxcedema  and  cretinism. 

"  It  is  not  surprising,  therefore,  that  it  should  be 
able  to  deal  also  with  gummata  and  atheroma." 

This  question  of  thyroid  treatment  is  so  inti- 
mately connected  with  the  symptoms  of  senile  degen- 


ii6   ROAD  TO  A  HEALTHY  OLD  AGE 

eration  and  with  its  preceding  years  that  one  is 
compelled  to  give  it  the  greatest  consideration. 

At  the  risk  of  wearying  my  readers,  I  must  give 
them  the  general  conclusions  arrived  at  by  those 
eminent  men  Biedl  and  Eppinger.  (My  readers  can, 
if  they  like,  skip  the  scientific  arguments  and  try  to 
grasp  the  lessons  that  are  taught. ) 

"  The  thyroid  and  the  suprarenal  system,  to- 
gether with  the  infundibular  portion  of  the  pituitary, 
constitute  a  group  of  vascular  glands  which  augment 
and  accelerate  the  processes  of  metabolism.  The 
balance  is  maintained  by  the  antagonistic  activity  of 
those  other  vascular  glands,  like  the  pancreas  and 
the  parathyroids,  which  exercise  a  restraining  influ- 
ence upon  metabolism.  These  two  groups  of  in- 
ternal secretory  glands  possess  physiological  inter- 
relationship with  one  another.  The  extirpation  of 
a  vascular  gland  is  followed  by  differing  sets  of 
phenomena:  firstly,  there  are  the  direct  results  due 
to  the  supression  of  the  specific  secretion ;  secondly, 
there  are  the  indirect  results  due  to  derangement 
of  the  other  glands,  the  functions  of  which,  under 
normal  conditions,  were  either  stimulated  or  inhib- 
ited by  the  secretion  of  the  removed  gland. 

"  The  thyroid  is  believed  to  promote  the  activity 
of  the  suprarenal  or  chromaffin  system  and  to  inhibit 


PREMATURE  SENILITY  117 

that  of  the  pancreas.  The  direct  results  of  the 
removal  of  the  thyroid  consist  in  reduction  of  the 
metabolism  of  albumin,  fat,  and  salts;  the  indirect 
results  are,  on  the  one  hand,  the  absence  of  stimula- 
tion of  the  chromaffin  system,  and  on  the  other  a 
hyperactivity  of  the  pancreas,  due  to  the  removal  of 
the  inhibitory  agent. 

"  It  is  believed  that  the  nervous  system  is  the 
agent  by  which  the  interactivities  of  the  vascular 
glands  are  affected.  That  group  of  them  which 
promotes  metabolism  has  a  sympathetic  innervation 
and  stimulates  the  sympathetic  nerves,  at  the  same 
time  exercising  an  inhibitory  effect  upon  the  autono- 
mous nerves.  The  group  which  retards  metabolism, 
on  the  other  hand,  possesses  an  autonomous  inner- 
vation, and,  while  stimulating  the  autonomous, 
inhibit  the  sympathetic. 

"  The  thyroid  possesses  a  double  function,  being 
furnished  with  both  classes  of  nerves,  and  is  thus 
able  to  affect  both  divisions  of  the  nervous  system." 

It  will  thus  be  seen  what  an  important  position 
the  thyroid  holds  in  our  economy,  and  what  enor- 
mous hints  for  treatment  of  morbid  conditions  and 
for  the  explanation  of  them,  the  study  of  this  subject 
suggests.  The  great  abdominal  sympathetic  gang- 
lion has  been  called  the  Clapham  Junction  of  the 


ii8  ROAD  TO  A  HEALTHY  OLD  AGE 

nervous  system ;  in  like  manner  the  thyroid  seems  to 
be  the  principal  centre  of  the  system  that  receives 
and  transmits  the  hormonic  or  chalonic  messages 
which,  passing  from  gland  to  gland,  stimulate  and 
control  the  problems  of  growth  and  nutrition  in  our 
bodies. 

The  results  of  total  removal  of  the  gland  described 
above  have  been  obtained  partly  from  experiments 
on  animals  and  partly  from  those  cases  in  human 
beings  where  the  gland  has  had  to  be  removed  for 
some  growth  in  the  gland  itself.  It  is  a  well-known, 
ascertained  fact  that  removal  of  the  thyroid  in  man 
produces  the  disease  called  myxoedema.  This  organ, 
like  many  others,  has  a  surplus  of  power  in  health, 
so  that  extraordinary  demands  can  be  met.  This  is 
shown  by  the  experience  of  surgeons  that  if  a 
quarter  of  the  gland  be  left  the  symptoms  of  myxoe- 
dema will  not  show  themselves. 

This  wonderful  machine  that  we  call  our  body 
differs  from  a  man-made  machine  in  its  wonderful 
elasticity  and  reserves  of  force.  If  we  could  only 
devise  spare  parts  to  add  to  the  spare  force,  we  could 
enter  into  a  race  with  Methuselah.  In  the  great 
majority  of  cases  of  premature  senility,  accompan- 
ied by  the  early  symptoms  of  sclerosis,  raised  1)lood- 
pressure,  etc.,  we  shall  find  many  of  the  signs  that 


PREMATURE  SENILITY  119 

belong  to  that  form  of  myxoedema  that  we  see  after 
total  removal  of  the  thyroid.  Here  thyroid  admin- 
istration will  give  good  results,  but  in  those  cases 
of  subthyroidism  where  there  is  subnormal  pressure 
we  often  find  a  very  poor  state  of  the  venous  circu- 
lation— cold  and  blue  hands  and  feet,  and  chilblains 
often.  The  vitality  is  low.  In  such  cases  much 
benefit  is  obtained  from  the  addition  of  suprarenal 
extract  to  the  thyroid,  and  by  giving  good  doses  of 
calcium  salts.  With  regard  to  the  importance  of 
these  calcium  salts,  Rendle  Short  says :  "  It  has  long 
been  recognized  that  they  are  essential  to  the  con- 
tinued success  of  perfusion  fluids,  and  now  we  know 
that  they  control  the  coagulation  and  viscosity  of 
the  blood,  and  probably  the  functions  of  the  ovary 
and  parathyroid  glands  also."  Remarkably  good 
results  have  been  obtained  by  giving  15  grains  of 
calcium  lactate  in  solution  three  times  a  day  before 
food  for  three  days  consecutively,  and  by  occa- 
sionally repeating  the  process. 

As  we  pass  on  to  real  old  age  we  often  find  the 
symptoms  of  thyroid  deficiency  still  more  marked 
and  of  much  graver  import.  We  are  only  beginning 
to  realize  how  much  senility  depends  on  internal 
gland  insufficiency.  Biedl  says :  "  A  special  patho- 
genetic significance  is  ascribed  to  thyroid  insuffi- 


I20  ROAD  TO  A  HEALTHY  OLD  AGE 

ciency  in  the  changes  which  occur  in  later  life,  and 
which  are  included  in  the  term  *  senile  degeneration.' 
The  foundation  for  the  theory  that  old  age  results 
from  changes  in  the  thyroid  lies  in  the  fact  that  in 
old  age  this  gland  becomes  atrophied,  its  follicles 
shrink,  and  retrogressive  changes  take  place  in  the 
epithelial  cells.  This  is  reinforced  by  the  fact  that 
there  is  a  profound  analogy  between  the  signs  of 
advanced  old  age  and  those  of  myxoedema.  The  fall- 
ing of  the  hair  and  the  dropping  out  of  the  teeth, 
the  dry  and  wrinkled  skin,  the  lowered  body  temper- 
ature, the  diminished  perspiration,  the  indolent 
digestion  and  consequent  emaciation,  the  reduced 
metabolism,  the  decrease  of  mental  power,  and  the 
diminished  activity  of  the  whole  nervous  system — 
these  are  all  symptoms  which  characterize  chronic 
myxoedema." 

The  late  Sir  Victor  Horsley  held  the  view  that 
"  Senility  is  due,  at  any  rate  in  part,  to  thyroid 
degeneration,  while  myxoedema  may  be  described 
as  a  condition  of  premature  senility.'* 

The  following  case  is  an  illustration  of  my  argu- 
ment :  "  A  man  aged  eighty  years,  who  for  some 
time  had  shown  the  early  signs  of  brain  degenera- 
tion, suddenly,  after  some  extra  fatigue,  collapsed. 
He  was  almost  unconscious  and  lay  prostrate  on  his 


PREMATURE  SENILITY  121 

back.  For  days  he  could  hardly  swallow,  the  power 
over  both  sphincters  was  completely  in  abeyance, 
bedsores  formed,  and  he  seemed  to  be  a  hopeless 
dying  case;  yet  there  was  nO'  aphasia  and  no  true 
paralysis;  he  could  just  move  every  limb  if  pressed 
to  do  so ;  reflexes  were  present,  but  feeble.  Arterial 
tension  was  165  mm.  As  a  forlorn  hope  I  gave  him 
thyroid  extract,  5  grains  of  fresh  gland  daily.  He 
at  once  began  to  improve;  in  a  fortnight  all  incon- 
tinence was  gone;  he  could  swallow  well,  and  the 
bedsores  healed.  After  three  months*  continuous 
thyroid  treatment,  he  could  walk  two  miles  a  day, 
his  tension  was  140  mm.,  and  his  mental  condition 
was  somewhat  improved.  No  other  medicinal  treat- 
ment was  given,  and  I  think  thyroid  may  fairly 
claim  the  honor  of  the  results."  (This  man  lived 
for  eighteen  months  after  the  attack  described.) 

In  many  cases  of  bladder  weakness  in  old  age  and 
in  both  sexes  where  there  is  partial  incontinence, 
the  careful  use  of  thyroid  will  often  give  good  re- 
sults. In  old  men  with  enlarged  prostates  we  see 
no  rapid  eiifects,  but  there  is  accumulating  evidence 
to  show  that  thyroid  feeding  controls  and  lessens 
the  growth  of  the  gland,  and  so  in  time  relief  may 
come.  When  one  considers  how  much  the  thyroid 
and  parathyroid  glands  are  concerned  with  calcium 


122  ROAD  TO  A  HEALTHY  OLD  AGE 

metabolism,  one  must  realize  how  much  assistance 
they  may  give  in  the  circulatory  troubles  of  thyroid 
disturbance;  and  is  it  not  reasonable  to  think  that 
this  increased  metabolism  and  excretion  of  calcium 
may  have  some  beneficial  effect  on  the  atheromatous 
deposits  that  in  the  later  stages  of  sclerosis  so  often 
occur  in  the  arteries,  and  which  are  probably  the  site 
and  cause  of  cerebral  haemorrhage?    If  the  depress- 
ing effects  of  thyroid  feeding  are  too  great,  there  is 
no  need  for  alarm ;  they  soon  pass  off,  and  the  treat- 
ment can  be  continued  with  lesser  doses  or  with 
some  compensating  help.    In  treating  a  case  of  high 
blood-pressure,  it  is  very  necessary  to  estimate  care- 
fully the  condition  of  the  heart.    We  may  find  no 
murmurs,  but  we  shall  often  find  dilatation,  the 
heart's  apex-beat  in  the  nipple  line  or  outside  it.    If 
this  is  so,  it  is  very  important  to  brace  up  the  heart's 
muscle  at  the  same  time  as  we  lower  the  peripheral 
resistance,   otherwise  the  heart's  muscular  action 
may  become  irregular  and  disturbed;  it  has  been 
timed  to  work  against  a  certain  resistance,  and  it 
does  not  quickly  tune  its  timing  apparatus  to  fit  the 
new  circumstances.     Strophanthus,  I  think,  is  the 
best  vegetable  medicine  for  this  purpose,  as  it  has  no 
effect  on  the  blood-pressure  in  the  smaller  arteries ;  it 
should  be  given  in  full  doses.    Spartein  sulphate  also 


PREMATURE  SENILITY  123 

does  fairly  well.  In  a  few  cases  digitalis  may  be 
necessary,  but  it  should  be  given  for  a  very  few  days. 
There  is  much  variance  of  opinion  as  to  whether 
digitalis  increases  arterial  blood-pressure  or  not,  but 
'from  many  observations  I  feel  pretty  sure  that  it 
does  so  when  the  arteries  are  diseased.  I  have  come 
across  many  cases  where  this  drug  has  been  given 
to  meet  the  heart  symptoms  of  arterio-sclerosis  and 
where  the  symptoms  have  become  steadily  worse. 
Sodium  nitrite  or  a  good  dose  of  hippurate  given  at 
the  same  time  will  help  much,  but  there  are  few  cases 
that  will  not  answer  to  strophanthus. 

This  question  as  to  the  action  of  digitalis  on  the 
arterioles,  and  consequently  on  blood-pressure,  is 
a  very  important  one,  and  should  be  definitely  de- 
cided by  experimenting  physiologists.  Mackenzie, 
in  his  experiments  at  the  Mount  Vernon  Hospital, 
has  come  to  the  conclusion  that  it  does  not  often 
raise  pressure,  and  Dr.  F.  W.  Price  confirms  this 
view.  On  the  other  side  Brunton  says :  "  It  is  now 
generally  recognized  that  digitalis  has  ( i )  the  power 
of  slowing  the  heart,  (2)  of  making  it  stronger,  (3) 
of  contracting  the  vessels."  Later  on  he  says: 
"  Digitalis  acts  on  the  cardiac  muscle,  the  intrinsic 
cardiac  nerve,  and  the  vagus  centre  in  the  medulla. 
It  also  affects  the  arterioles,  causing  them  to  con- 


124  ROAD  TO  A  HEALTHY  OLD  AGE 

tract ;  and  probably  it  has  upon  them  also  a  twofold 
action,  as  on  the  heart,  stimulating  both  the  con- 
tractile muscular  walls  and  the  nerves  which  go  with 
them."  Sir  William  Whitla,  a  very  careful  observer, 
says :  "  Its  action  upon  the  arterioles  must  always 
be  remembered,  for  by  increasing  peripheral  resist- 
ance it  raises  the  renal  and  general  blood-pressure.'* 
Clifford  Allbutt,  *'  Dictionary  of  Medicine,"  vol.  v., 
p.  961,  says :  "  Tone  we  may  define  as  that  property 
in  heart,  artery,  or  other  hollow  viscus,  which  pre- 
serves the  mean  diameter  of  the  part ;  contraction  as 
that  which  enables  the  organ,  nevertheless,  to  obey 
stimulus  and  to  perform  particular  acts.  The  ver- 
micular movements  of  the  bowel  and  of  an  arteriole 
are  due  to  the  quality  of  contractibility ;  their  tone 
preserves  their  mean  diameter  in  spite  of  distension 
or  contraction.  Were  it  not  for  tone  a  hollow  organ, 
often  subject  to  extravagant  demands,  would  be 
strained  and  perhaps  ruptured.  In  the  heart  it  is 
tone  which  does  much,  if  not  all,  to  prevent  loss  of 
form  under  the  great  variations  of  internal  pres- 
sure." Farther  on  he  says :  "  Digitalis  produces  a 
distinct  increase  of  tone,  which  may  be  pushed  to  a 
degree  inconsistent  with  normal  function."  Again 
he  says :  "  Tone,  then,  is  the  quality  to  be  watched 
and  supported,  and  in  digitalis  we  have  a  means  of 


PREMATURE  SENILITY  125 

intensifying  tone  and  of  moderating  distensibility. 
Now  tone,  like  any  other  quality  in  excess,  may  be 
injurious,  and  the  output  of  the  constringed  vent- 
ricle may  fall  short  of  the  demands  of  the  system. 
Again,  when  the  muscle  falls  into  degeneration 
digitalis  seems  to  have  other  injurious  actions,  the 
nature  of  which  is  obscure." 

May  we  not  extend  this  argument  from  the  heart 
muscle  to  the  arterial  muscular  coats?  And  will 
not  careful  observation  of  arterial  pressure  be  the 
guide  to  the  use  of  this  powerful  remedy?  If  we 
give  enough  digitalis  to  render  perfect  the  tone  of 
the  ventricle  and  not  to  pass  beyond  that  point,  we 
shall  probably  be  doing  the  same  for  the  musculature 
of  the  arterioles,  and  thereby  improve  the  general 
condition  of  the  circulation  and  also  the  nutrition 
of  the  arterial  coats  themselves.  But  if  we  press 
beyond  this  normal  tone-point,  it  is  easily  seen  that 
we  increase  peripheral  resistance  and  so  embarrass 
and  add  to  the  work  of  the  heart.  In  arterio-sclero- 
sis,  I  think,  we  often  get  signs  of  arterial  degenera- 
tion before  the  heart  muscle  is  affected,  and  it  may 
be  in  those  cases  that  digitalis  is  especially  harm- 
ful. 

I  have  gone  rather  fully  into  this  question,  as  I 
have  so  often  seen  this  most  valuable  drug  misused, 


126  ROAD  TO  A  HEALTHY  OLD  AGE 

and  by  misuse  do  harm.  Neither  men  nor  medicines 
should  lose  their  reputations  by  being  used  in  the 
wrong  way  and  in  the  wrong  place. 

A  most  useful  way  of  giving  digitalis  is  the  old 
St.  George's  Hospital  pill  composed  of  blue  pill, 
squills,  and  digitalis : 


^    Pil.  hydrarg gr.  i 

Pulv.  digitalis    gr.  ij^ 

Pil.  scillae  co gr.  2 

Ft.  pil.  T.d.s. 


Here  the  mercury,  which  is  one  of  the  most  power- 
ful tension  depressors  we  have,  counteracts  the 
effect  of  the  digitalis  on  the  arteries ;  it  at  the  same 
time  helps  the  liver  to  unload,  while  the  squills  act 
as  a  diuretic  and  as  a  heart  tonic  also.  It  is  no 
exaggeration  to  say  that  this  happy  combination  has 
pulled  many  a  failing  heart  back  into  safety.  A  dose 
of  calomel  or  blue  pill  once  a  week  is  a  very  good 
rule  for  this  disease.  Whether  it  acts  by  unloading 
the  liver  or  by  its  bactericidal  power  in  the  intes- 
tines, or  by  both,  I  know  not;  but  the  result  is 
undoubtedly  good. 

In  treating  the  blood-pressure  with  thyroid,  some 
heart  tonic  is  often  required.     The  manufacturing 

chemists  of  England  and  America  have  lately  intro- 


PREMATURE  SENILITY  127 

duced  some  very  good  combinations  of  internal, 
gland  extracts.  The  English  preparations,  so  far 
as  I  know,  have  all  got  pituitary  or  suprarenal  in* 
them,  and  this  renders  them  unsuitable  for  most 
cases  of  sclerosis;  they  are  excellent  nerve  and 
body  tonics,  but  they  all  tend  to  raise  pressure. 
Carnrick  and  Company  of  New  York  have  placed  on 
the  market  a  most  useful  tablet  which  they  call 
"  Hormotone."  There  are  two  preparations,  one 
with  pituitary  and  one  without;  the  latter,  of  course, 
is  for  use  in  sclerosis  and  in  high  blood-pressure ;  it 
is  one  of  the  most  valuable  preparations  that  I  have 
used  for  reducing  tension.  It  causes  no  headache 
and  little  or  no  cardiac  depression.  It  is  composed 
of  thyroid,  ovary,  and  testis.  The  stimulating  effects 
of  the  ovary  and  testis  extracts,  both  on  the  nervous 
system  and  on  metabolism,  seem  to  help  the  good 
effect  of  the  thyroid  and  to  counterbalance  its 
depressing  effect  on  the  heart.  I  hope  some  of  our 
big  manufacturing  chemists  will  place  such  a  tablet 
on  our  market  before  long.  In  my  experience  better 
effects  are  obtained  by  this  combination  than  by 
thyroid  alone.  In  January,  19 17,  Carnrick  and 
Company  put  on  our  market  another  hormotone, 
which  has  the  addition  of  an  extract  of  the  anterior 
portion  of  the  pituitary  gland.    As  far  as  I  can  at 


128  ROAD  TO  A  HEALTHY  OLD  AGE 

present  judge  this  is  a  distinct  improvement  in  some 
cases,  in  the  treatment  of  high  blood-pressure. 

A  most  interesting  problem  for  solution  has  been 
opened  in  Italy  by  Dr.  Marabotto.  With  intra- 
venous injections  of  a  watery  extract  of  suprarenal, 
he  has  produced  decided  atheroma  in  the  aorta  of 
rabbits  (no  such  effect  was  produced  by  subcu- 
taneous or  oral  administration).  The  removal  of 
the  thyroid  or  great  thyroid  deficiency  is  known  to 
cause  atheroma  also.  Is  this  result  due  merely  to 
absence  of  thyroid  secretion?  Or  it  is  due  to  the 
suprarenal  secretion  losing  its  natural  counterweight 
and  so  acting  on  the  arterial  system  unchecked? 
Thyroid  is  supposed,  and  rightly,  I  think,  to  be  an 
activator  or  hormone  to  the  chromaffin  glands,  of 
which  suprarenal  is  one  of  the  most  important.  It 
looks  as  if  it  were  at  the  same  time  an  activator  and 
an  antidote,  or  at  any  rate  a  check.  An  interesting 
complement  to  this  experiment  of  Marabotto' s  would 
be  to  give  full  thyroid  feeding  to  the  rabbits  while 
under  this  suprarenal  treatment. 

Dr.  Marabotto's  further  experiments  and  results 
with  a  suprarenal  toxic  serum  are  full  of  interest 
and  hope  from  the  therapeutic  point  of  view,  and 
his  final  results  may  turn  out  to  be  most  important. 

There  is  a  temptation  to  take  narrow  views  about 


PREMATURE  SENILITY  129 

the  properties  of  all  the  internal  secretion  glands. 
We  think  of  thyroid  as  a  tension  depressor  and  of 
suprarenal  and  pituitary  as  tension  raisers,  and  to  a 
'certain  point  we  are  right.  We  gain  our  immediate 
object,  at  any  rate,  when  we  administer  one  or  other 
of  them  by  the  mouth  or  by  subcutaneous  injection, 
but  when  one  thinks  of  all  these  glands  of  the  animal 
economy  working  simultaneously,  and  in  health 
harmoniously,  and  of  all  of  them  linked  up  together 
by  a  sort  of  wireless  telegraphy,  the  problem  becomes 
much  more  intricate.  We  may  use  gland  extracts 
such  as  thyroid  or  suprarenal  for  one  definite  action 
and  purpose,  but  we  must  not  forget  that  their  influ- 
ence may  spread  far  beyond  our  original  plan. 

The  thoughtful  study  of  the  physiological  and 
therapeutic  properties  of  all  these  internal  glands 
seems  to  me  to  be  of  the  utmost  importance;  they 
are  Nature's  own  remedies ;  they  are  the  chief  wea- 
pons with  which  she  meets  all  emergencies,  not  only 
of  disease,  but  of  abnormal  external  circumstances. 
Take,  for  example,  the  case  of  suprarenal  extract. 
Dr.  George  Murray,  in  his  article  in  the  Practitioner 
of  February,  191 5,  says :  "  It  has  been  clearly  shown 
that  under  the  influence  of  a  strong  stimulus,  such 
as  fright,  adrenine  is  rapidly  discharged  into  the 
adrenal  veins  and  so  into  the  general  circulation.    It 


I30  ROAD  TO  A  HEALTHY  OLD  AGE 

is  interesting  to  follow  up  the  effects  of  this  condi- 
tion of  adrenalsemia  and  to  see  how  useful  they  may 
be  to  an  animal  either  in  contending  with  or  in 
escaping  from  the  cause  of  fear.  The  excess  of 
adrenine  dilates  the  coronary  arteries,  gives  the  heart 
a  larger  supply  of  blood,  increases  the  strength  of 
the  cardiac  contractions,  and  raises  the  blood-pres- 
sure. It  tends  to  divert  the  chief  flow  of  blood 
from  the  abdominal  vessels  to  those  of  the  central 
nervous  system,  heart,  lungs,  and  muscles.  The 
adrenine  thus  stimulates  just  those  activities  which 
an  animal  employs  either  in  fighting  a  foe  or  in 
escaping  from  an  enemy.  In  addition  to  this,  the 
adrenine  mobilizes  the  store  of  glycogen  in  the  liver, 
thus  increasing  the  amount  of  sugar  in  the  blood  and 
rendering  it  available  for  use  in  the  muscular  action 
entailed  in  effort." 

With  the  leucocytes  of  the  blood,  they  stand  at  the 
door  and  guard  against  the  entry  of  the  poisonous 
bacteria  from  without.  An  everyday  proof  of  this 
is  the  increased  liability  to  tuberculosis  and  the  other 
bacterial  invasions  that  we  find  in  Addison's  disease 
and  in  cretinism,  these  being  examples  of  suprarenal 
and  thyroid  deficiency  respectively. 

These  glands  are  like  the  keyboard  of  an  organ, 
by  the  trained  and  skilful  use  of  which  we  can  pro- 


PREMATURE  SENILITY  131 

duce  effects  fortissimo  and  pianissimo,  by  which  we 
can  produce  harmonies  and  discords,  and  by  which 
we  can  resolve  the  discords  of  disease  into  the  har- 
monies of  health.  The  study  of  these  internal  glands 
only  belongs  to  the  recent  years,  and  one  may  ques- 
tion whether  our  knowledge  or  our  ignorance  of 
them  would  weigh  down  the  balance,  but  I  think  we 
know  enough  to  see  in  part  their  great  value  and  to 
have  the  assurance  that  patient  and  honest  use  and 
investigation  will  largely  increase  that  value. 

It  is  not  alone  in  morbid  abnormal  conditions  that 
these  glands  are  of  such  value,  but,  as  Brown- 
Sequard  thought  and  experienced,  they  can  maintain 
the  vitality  and  activity  both  of  body  and  mind  in 
advancing  years,  and  this  they  do,  not  by  artificial 
temporary  stimulation,  but  by  supplying  from  with- 
out the  life  and  power  giving  secretions,  whose  sup- 
ply is  failing  within.  For  this  work  the  best  gland 
extracts  are,  I  think,  those  of  the  ovary,  testis,  and 
thyroid;  with  them  should  be  combined  infundibulin 
or  pitglandin  (the  former  coming  from  the  posterior 
portion  of  the  pituitary  and  the  latter  from  the  an- 
terior) ;  a  supernormal  or  subnormal  blood-pressure 
will  indicate  the  right  combination,  but  I  have  no 
doubt  that  a  wise  combination  acts  better  than  any 
single  gland.     In  extreme  old  age,  when  blood- 


132  ROAD  TO  A  HEALTHY  OLD  AGE 

pressure  naturally  falls,  suprarenal  extract  may  also 
be  of  great  value.  The  value  of  pitglandin  is  as  yet 
hardly  recognized.  I  ask  my  confreres  who  are 
getting  old  and  tired  to  try  this  treatment  on  them- 
selves, for  I  feel  sure  that  their  strength  and  the 
value  of  their  work  will  increase. 

There  has  been  some  confusion  and  doubt  as  to 
dosage,  caused  by  some  writers  using  the  fresh 
gland  and  some  the  dried  extract;  it  will,  I  think, 
be  a  help  if  I  give  the  following  relations,  which 
are  approximately  correct : 

British  Pharmacopcria. 
I  grain  of  dried  thyroid=:3^  parts  of  fresh  gland. 

Armour*s  Dried  Powder. 
I  grain  dried  orchitic       =7  grains  fresh  gland 
I  grain  dried  ovarian        =7  grains  fresh  gland 
I  grain  dried  pituitary      =4  grains  fresh  gland 
I  grain  dried  suprarenal  =6  grains  fresh  gland 

It  will  be  well  in  prescribing  to  use  the  dried 
extract  as  far  as  possible,  but  most  of  our  English 
makers  have  issued  tablets  containing  5  grains  or 
2j^  grains  of  fresh  gland;  this  especially  applies  to 
the  thyroid  and  suprarenals.  Carnick's  Hormotones 
without  pituitary  contain  only  i/io  grain  of  dried 
thyroid  extract,  and  from  three  to  six  tablets  are 
taken  daily.     The  larger  dose   (6  tablets)   would 


PREMATURE  SENILITY  133 

represent  3/5  grain  of  dried  thyroid  a  day,  whereas 
one  of  our  English  5-grain  tablets  would  contain 
about  I  %  grains.  Most  people  cannot  take  so  much 
as  this,  1%  grains  daily,  without  showing  some  of 
the  depressing  effects  of  the  remedy.  A  very  good 
formula  for  a  combined  tablet  for  use  in  sclerosis 
as  a  tension  depressor  is : 

Dried  thyroid  gr.  % 

Dried  orchitic gr.  % 

Dried  ovarian  gr.  % 

This  is  about  double  the  strength  of  Carnick*s 
Hormotones,  and  consequently  two  or  three  daily 
would  be  an  efficient  dose.  These  are  made  and 
supplied  by  S.  Hardwick,  Poole  Hill,  Bournemouth. 

The  original  hormotone,  which  contains  pituitary, 
is  a  very  good  tonic,  but  generally  raises  pressure. 
As  I  have  said  before,  suprarenal  extract  may  safely 
be  used  as  a  counterbalance  to  thyroid,  especially  in 
quite  old  people.  Suprarenal  is  the  most  useful  tonic 
we  at  present  possess  in  the  physical  weakness  of 
extreme  old  age,  and  may  be  used  fearlessly;  com- 
bined with  phosphorus  (especially  in  the  form  of 
lecithin)  as  a  brain  food  it  often  gives  astonishing 
results. 

There  are  other  gland  extracts,  such  as  thymus, 


134  ROAD  TO  A  HEALTHY  OLD  AGE 

pancreas,  etc.,  which  are  used  with  success  in  other 
morbid  conditions,  but  this  is  not  the  place  for  their 
consideration.  The  whole  subject  is  so  full  of  inter- 
est that  one  knows  not  where  to  stop,  but  if  one  let 
oneself  go  the  chief  points  of  one's  sermon  would 
run  a  risk  of  being  overwhelmed  under  the  boredom 
of  the  unhappy  reader. 

The  condition  of  the  blood  itself  I  have  not  yet 
mentioned,   but  it  is  an  important   consideration. 
There  can  be  no  doubt  that  the  viscosity  or  thickness 
of  the  blood  fluid  varies,  and  it  must  be  evident  that 
increased  viscosity  means  a  call  for  increased  driv- 
ing power  from  the  heart.    This  is  a  subject  which 
has  not  been  fully  worked  out.    Many  people  drink 
far  too  little  fluid  even  in  health;  half  a  pint  or  a 
little  more  for  breakfast,  half  a  pint  or  less  for 
lunch,  half  a  pint  for  tea,  and  half  a  pint  for  dinner, 
is  nearly  the  usual  custom,  and  this  represents  about 
30  ounces  of  fluid  daily.    There  is  some  more  taken, 
of  course,  in  the  food,  but  the  total  is  not  enough. 
Another  pint  taken  between  or  before  meals  would 
generally  be  beneficial,  and  would  tend  to  thin  the 
blood.    There  seems  to  be  little  doubt  that  oxygen- 
lessens  the  viscosity  of  the  blood.    Sir  Lauder  Brun- 
ton  has  found  that  in  bleeding  from  a  vein,  the 
inhalation  of  oxygen  will  cause  blood  too  thick  to 


/  PREMATURE  SENILITY  135 

flow  to  come  readily,  and  I  can  corroborate  his  ex- 
perience. Probably  with  a  sedentary  indoor  life  the 
viscosity  of  the  blood  increases.  This  points  the 
lesson  that  everyone  with  this  tendency  should  live 
and  sleep  as  much  as  possible  in  good  pure  air,  and 
that  he  should  take  what  outdoor  exercise  he  can. 
Well-regulated  exercise  spreads  the  circulation  of 
the  blood  over  a  much  larger  area ;  in  rest  the  blood 
to  a  large  extent  collects  in  our  internal  reservoirs 
and  becomes  partially  stagnant,  but  exercise  sends 
it  coursing  through  all  the  arteries  and  veins  of  our 
limbs,  and  thus  internal  congestion  and  viscosity  are 
simultaneously  relieved. 

Here  I  must  emphasize  the  great  value  of  bleed- 
ing in  cases  of  very  high  tension,  especially  where 
there  is  evidence  of  congestion  in  the  brain  (this  is 
generally  marked  by  a  feeling  of  fulness  and  pain  at 
the  back  of  the  head  and  neck),  and  also  in  those 
cases  where  there  is  much  difficulty  in  breathing. 
Owing  to  the  embarrassed  state  of  the  heart  and 
circulation  generally,  we  see,  not  infrequently,  sud- 
den attacks  of  engorgement  of  the  lungs,  causing 
great  dyspnoea  and  the  expectoration  of  blood- 
stained, frothy  mucus,  the  face  and  lips  becoming 
blue.  Here  bleeding  acts  like  a  charm ;  as  the  blood 
flows,  all  the  distress  quietly  but  quickly  subsides. 


136  ROAD  TO  A  HEALTHY  OLD  AGE 

In  such  cases  bleeding  from  the  arm  veins  is  no 
doubt  the  wisest  method,  but  in  the  head  cases,  I 
think,  we  get  better  results  by  applying  leeches  to  the 
back  of  the  neck;  the  blood  should  be  encouraged  to 
flow  quietly  for  an  hour  or  so  after  the  leeches  have 
fallen  off.     If  the  pain  is  in  front,  the  leeches  can 
be  put  on  the  temples.    Any  f aintness  that  may  arise 
is  quickly  relieved  by  a  hypodermic  injection  of 
strychnine.    The  good  that  results  is  no  doubt  due, 
not  to  the  mere  emptying  of  the  bloodvessels,  but  to 
the  alteration  of  the  quality  of  the  blood;  for  as 
soon  as  the  vessels  are  partially  emptied,  they  fill  up 
again,  by  extracting  the  watery  constituents  of  the 
tissues,  and  thus  the  viscosity  of  the  blood  is  reduced. 
In    dieting    patients    with    arterio-sclerosis,    we 
should  be  careful  not  to  give  them  food  that  contains 
too  much  calcium ;  in  ordering  them  to  give  up  meat 
we  often  err  by  giving  them  too  much  milk.    We 
should  bear  in  mind  that  coagulability  of  the  blood 
is  increased  by  carbonic  acid,  calcium,  magnesia, 
and  milk,  and  diminished  by  oxygen,  alcohol,  di- 
minution of  lime  salts,  and  by  the  fruit  acids;  the 
effects  of  carbonic  acid  and  oxygen  in  this  relation 
strengthen  the  argument  for  a  non-sedentary,  open- 
air  life.    Sir  James  Barr  says  that  "  fixed  lime  (in 
the  albumin  molecule)  increases  viscosity  and  coagu- 


PREMATURE  SENILITY  137 

'lability,  while  the  free  calcium  ions,  in  association 
with  the  suprarenal  and  pituitary  secretions,  increase 
the  tone  and  contraction  of  the  arteries  and  arteri- 
oles, heighten  blood-pressure,  and  maintain  force 
and  efficiency  of  the  cardiac  contractions."  The 
popular  view  that  milk  in  quantity  is  a  wholesome 
food  for  adults  in  all  circumstances  is  thus  shown  to 
be  wrong.  It  points  also  to  the  great  value  of  fruit 
in  the  diet  of  old  people;  even  the  much-abused 
rhubarb,  though  injurious  in  some  ways,  lessens  the 
viscosity  of  the  blood.  The  thoughtful  man  will  see 
that  in  this  disease  a  wide  and  philosophical  view 
must  be  taken  of  the  whole  subject.  The  heart,  the 
bloodvessels,  the  circulating  fluid,  the  vaso-motor 
nervous  system,  and  the  whole  method  of  life,  have 
to  be  taken  into  careful  consideration. 

There  remain  in  the  treatment  of  this  disease  the 
questions  of  balneology  and  electricity.  The  Nau- 
heim  treatment,  whether  carried  out  there  or  in 
England,  acts,  perhaps,  as  much  by  reducing  arterial 
tension  and  peripheral  resistance  as  by  any  direct 
action  on  the  dilated  heart;  the  immediate  effect  of 
the  bath  is  to  produce  great  dilatation  of  the  surface 
arterioles  and  capillaries  of  the  skin — in  fact,  cu- 
taneous hyperoemia  of  a  most  active  kind;  this 
naturally  lessens  the  amount  of  blood  in  the  internal 


138  ROAD  TO  A  HEALTHY  OLD  AGE 

reservoirs,  and  enables  the  heart  to  do  its  work 
with  more  ease  and  less  resistance.  In  the  Practi- 
tioner of  August,  19 1 2,  is  a  clear  and  instructive 
article  by  Dr.  Thorne  on  the  effect  of  Nauheim 
treatment  on  arterio-sclerosis  when  carried  out  at 
home.  Other  natural  waters,  such  as  those  of 
Llangammarch  Wells  in  Wales,  can  be  used,  but  the 
imitations  with  ordinary  waters,  or  especially  with 
sea-water,  seem  to  have  nearly  as  good  results. 
Judicious  hydropathic  treatment  may  often  give 
help  in  many  ways.  In  the  early  stages  of  the  dis- 
ease the  high-frequency  electrical  treatment  is  often 
successful  as  an  aid  to  other  methods,  and  its  action 
is  more  than  a  passing  one.  In  the  later  stages  it  is 
not  of  much  use  in  my  experience,  but  in  these  the 
Bergonie  Faradic  method  seems  very  promising, 
especially,  perhaps,  where  there  is  obesity.  It  is, 
perhaps,  hardly  necessary  to  say  that  these  treat- 
ments must  be  carried  out  by  physicians  who  have 
made  a  study  of  electricity,  and  who  know  its  risks 
and  its  limitations. 

I  will  now  endeavor  to  condense  the  foregoing 
theories  and  facts  into  a  more  practical  shape.  We 
may  roughly  divide  the  cases  of  arterio-sclerosis 
into  three  divisions ;  the  first  in  which  there  is  only 
raised  blood-pressure,  and  that  not  constant,  in  which 


PREMATURE  SENILITY  139 

there  is  no  sign  of  kidney  disease  nor  of  palpable 
arterial  thickening;  in  this  stage  we  often  find  a 
tendency  to  heart  dilatation,  but  it  is  often  only 
evident  after  exertion.  This  class  occurs  very  fre- 
quently in  women  about  fifty,  and  should  be  treated 
quickly  and  thoroughly;  for  now  it  is  easily  cured, 
but  if  neglected  may  drift  on  insidiously  into  real 
disease.  This  condition  one  finds  also  in  men,  but 
generally  earlier  in  life;  about  forty-five  to  fifty  the 
anxious,  overworked  man  or  the  intemperate  may 
show  the  first  symptoms.  In  both  sexes  5  or  6  grains 
daily  of  hippurate,  with  some  strophanthus,  will 
bring  the  tension  down  to  normal,  but  to  get  a  per- 
manent result  the  treatment  must  be  continued  in 
lessening  doses  for  some  months.  It  is  well  to  take 
such  patients  fully  into  one's  confidence,  and  to 
explain  the  treatment  and  the  dangers  of  neglect. 
If  on  careful  examination  one  finds  signs  of  sub- 
thyroidism,  one  may  bring  down  the  tension  with 
thyroid  or,  better  still,  with  the  compound  tablet  I 
have  mentioned — Carnrick's  without  pituitary.  In 
using  either  of  these  the  weight  should  be  watched — 
naturally  stout  people  stand  them  better  than  the 
thin ;  with  this  gland  treatment  the  heart  may  require 
toning  up  also.  The  rules  for  diet,  rest,  and  exercise 
must,  of  course,  be  given.    These  and  the  next  class 


I40  ROAD  TO  A  HEALTHY  OLD  AGE 

are  they  that  run  about  the  world  seeking  for  some 
new  nerve  tonic  or  some  new  stimulant,  and  that 
spend  their  money  on  something  that  is  worse  than 
vain,  for  they  know  not  their  own  disease. 

In  the  second  class  the  symptoms  are  much  the 
same,  but  more  constant;  the  blood-pressure  yields 
with  difficulty  to  treatment,  or  cannot  be  brought 
below  150  to  160  mm.  The  heart  is  generally  per- 
manently, though  slightly,  enlarged,  and  there  are 
early  signs  of  kidney  troubles.  Women  in  this  stage 
are  often  unhappy  and  depressed,  but  men  are  often 
brimming  over  with  a  sort  of  false  energy ;  in  both 
there  is  generally  shortness  of  breath  on  exertion. 
The  treatment  is  much  the  same  as  in  the  first  class, 
but  will  need  more  perseverance  and  watching,  and 
no  real  cure  can  be  expected.  The  evil  day  may, 
however,  be  long  postponed.  In  both  these  classes 
the  electrical  and  the  bath  treatments  mentioned  be- 
fore are  often  of  much  help. 

In  the  third  class,  where  there  is  distinct  heart 
and  kidney  disease,  and  especially  where  there  is 
atheroma,  one  must  proceed  very  cautiously.  In 
these  there  is  no  normal  point  of  tension.  One  must 
find  out  in  each  case  the  point  at  which  the  patient 
feels  most  comfortable  and  capable.  One  will  live 
fairly  easily  at  a  pressure  of  165  to  175  mm.,  and 


PREMATURE  SENILITY  141 

will  be  good  for  nothing  at  145  mm.  Nature,  as 
she  usually  does  in  abnormal  circumstances  when 
left  to  herself,  has  established  a  fair  working  equi- 
librium which  should  not  be  roughly  disturbed.  The 
extreme  degrees  of  tension,  such  as  200  mm.  or 
over,  should  certainly  be  attacked,  but  should  be 
brought  down  very  gradually.  These  patients,  if 
they  lead  careful  and  abstemious  lives,  may  still  live 
to  real  old  age,  but  they  cannot  afford  to  run  any 
risks  nor  to  make  exceptions  to  their  self-denying 
ordinances.  After  eighty  the  tendency  to  progres- 
sive sclerosis  generally  ceases,  the  arteries  become 
softer,  and  the  circulatory  stress  relaxes. 

The  chief  danger  in  this  third  class  is  atheroma, 
specially  when  it  occurs  in  the  aorta  or  in  the  cere- 
bral arteries.  In  such  cases  we  may  not  find  much 
pressure — sometimes,  indeed,  it  may  be  below  nor- 
mal; these  will  often  need  cardiac  tonics.  Thyroid 
or  the  combined  glands  with  pituitary  should  be 
carefully  given  and  watched.  If  there  is  advanced 
kidney  disease,  thyroid  may  do  harm;  the  results  of 
increased  metabolism  which  it  causes  may  have  no 
sufficient  outlet,  and  the  system  becomes  over- 
charged with  effete  materials.  In  the  second  and 
third  classes  it  is  very  necessary  to  keep  the  liver 
acting  freely;  occasional  doses  of  blue  pill  or  calomel 


142   ROAD  TO  A  HEALTHY  OLD  AGE 

at  night,  with  sulphate  of  soda  in  the  morning,  are 
most  beneficial,  and,  by  relieving  the  portal  circula- 
tion, lower  the  general  blood-pressure  and  ease  the 
work  of  the  heart. 

These  three  classes  have,  of  course,  no  clear  lines 
of  subdivision,  and  may  merge  into  each  other 
almost  insensibly,  but  they  form  a  fairly  accurate 
guide  to  prognosis  and  treatment. 

When  all  has  been  said  about  the  treatment  of 
this  morbid  condition  we  call  arterio-sclerosis,  we 
are  sure  to  be  faced  with  a  somewhat  sceptical 
criticism.  One  will  ask,  "  Is  not  this  thickening  of 
the  arterial  coats  with  the  increase  of  tension  Na- 
ture's method  of  keeping  up  a  failing  circulation?  " 
And  one  must  honestly  answer,  '*  Yes."  The  same 
criticism  would  apply  equally  to  the  case  of  hyper- 
trophy of  the  heart,  which  grows  stronger  and  bigger 
only  to  meet  an  increased  and  unnatural  demand : 
yet  no  one  would  hesitate  to  treat  and  rest  such  a 
heart.  The  sclerosis  is  a  fault  to  compensate  in  a 
measure  for  another  fault;  but  if  one  can  remove  or 
partially  cure  the  original  and  causative  error  one 
surely  may  and  should  treat  and  cure,  if  possible, 
the  resulting  error.  It  cannot  be  our  pharisaical 
duty  to  stand  by  and  see  the  vicious  circle  of  disease 
go  on  to  its  end  unbroken.    The  original  causes  of 


PREMATURE  SENILITY  143 

the  disease,  except  in  those  unhappy  cases  in  which 
the  tendency  is  inherited,  are  largely  removable,  for 
mostly  they  arise  from  physiological  law-breaking 
and  from  nervous  overstrain.  Let  us,  then,  throw 
aside  this  weight  of  paralyzing  hypercriticism,  a  sin 
that  doth  so  easily  beset  us,  and  let  us  march  fear- 
lessly but  cautiously  on  in  the  path  of  restoration 
and  of  healing.  After  all  our  arguments  and  specu- 
lations, the  court  of  appeal  that  has  to  pronounce 
judgment  is  formed  by  our  patients  themselves. 
Ask  any  man  or  woman  who  has  suffered  from  the 
miseries  and  discomforts  of  arterio-sclerosis,  when 
accompanied  by  high  blood-pressure,  how  they  feel 
after  that  pressure  has  been  carefully  and  judiciously 
reduced,  and  you  will  get  no  uncertain  answer.  They 
can  work  and  think  far  better,  their  breathing  is 
easier,  and  they  lose  the  cardiac  and  the  brain  dis- 
comforts that  have  made  their  lives  so  miserable. 
Their  sleep  becomes  again  quiet  and  refreshing; 
and  beyond  the  improvement  in  these  subjective 
symptoms,  there  is  a  condition  of  far  better  general 
health,  and,  what  is  perhaps  equally  important,  of 
greater  safety.  It  must  be  evident  that  anyone  at- 
tempting to  lead  a  strenuous  life  in  mental  or  bodily 
work,  with  a  pressure  much  above  the  normal,  is  in 
daily  danger  of  a  bad  breakdown,  of  one  that  will 


144  ROAD  TO  A  HEALTHY  OLD  AGE 

practically  end  his  working  days.  It  should,  there- 
fore, be  our  manifest  duty  to  bring  all  such  to  the 
knowledge  of  their  danger,  to  persuade  them  to  lead 
"a  new  life  and  to  grasp  the  means  of  safety  that  we 
can  offer  them.  During  the  last  few  years  it  has 
been  the  fortunate  lot  of  many  of  us  to  be  able,  with 
our  sclerotic  patients,  to  steer  them  safely  through 
the  dangerous  years  and  shoals  of  later  middle  life 
into  the  quiet  and  restful  harbor  of  real  old  age,  free 
from  paralysis  and  with  mind  unclouded. 

Note. — Since  the  above  chapter  was  written  the  experience 
of  others  and  myself  with  Pitglandin  (the  extract  of  the  pars 
anterior)  has  extended,  and  has  shown  its  great  value. 

This  is  not  to  be  wondered  at,  when  one  considers  the  in- 
fluence on  growth  and  development  exercised  by  this  part  of 
the  pituitary  gland. 

It  is  practically  non-poisonous,  and  can  be  given  in  large 
doses — up  to  30  grains  daily  of  the  fresh  extract.  It  acts  as 
a  tonic  to  the  whole  nervous  system,  and  yet  tends  to  lower 
blood-pressure;  it  is  therefore  very  valuable  in  the  debility  of 
old  age,  and  can  be  combined  with  thyroid  and  suprarenal  if 
necessary. 


CHAPTER  V 

CHRONIC    BRONCHITIS    AND    BRONCHIAL 

ASTHMA:  ITS  SCIENTIFIC  AND 

RATIONAL  CURE 

The  Microbe's  "Apologia  pro  vita  mea'* 

"Blindly  we  seem  to  labor. 
Whether  for  good  or  for  ill. 
But  God,  all-seeing,  Who  made  us, 
Knows  we  are  working  His  will. 

"Patient  unceasing  toilers 

In  the  welter  of  growth  and  decay, 
We  further  the  infinite  purpose 
Of  His  wondrous  alchemy." 

In  this  chapter  I  propose  to  discuss  the  origin  and 
treatment  of  that  form  of  chronic  bronchitis,  often 
connected  with  asthma,  that  so  cripples  and  shortens 
the  lives  of  elderly  people.  The  disease  called  pure 
spasmodic  asthma,  which  may  begin  without  bron- 
chitis, belongs  almost  entirely  to  earlier  years  and 
does  not  come  within  the  scope  of  this  article, 
though  the  vaccine  treatment  that  I  am  going  to 
describe  will  often  cure  it.  Especially  in  large  towns 
with  impure  smoky  atmosphere  this  disease  among 
the  elderly  gives  us  a  large  part  of  our  work,  and 

145 


146  ROAD  TO  A  HEALTHY  OLD  AGE 

often  much  worry  and  disappointment;  but  that  is 
of  little  consequence  compared  with  the  wretched 
health  and  the  premature  deaths  that  it  causes 
among  our  patients,  and  among  the  working  classes 
the  shortening  of  the  working  years  that  it  entails 
is  a  matter  of  serious  moment  both  to  the  individual 
and  to  the  nation. 

The  original  causes  are  not  always  the  same.  It 
may  begin  by  frequent  attacks  of  simple  head 
catarrh,  which  gradually  extend  to  the  bronchial 
mucous  membrane;  it  may  begin  with  influenza; 
it  may  arise  from  a  slight  attack  of  pneumonia  or 
of  broncho-pneumonia,  which  are  often  unrecog- 
nized and  untreated;  or  it  may  be  caused  by  con- 
tinued inhalation  of  irritant  gases  or  particles  that 
belong  to  their  trade.  Among  men  and  women  who 
have  to  live  and  work  in  such  unhealthy  surround- 
ings we  have  to  fight  this  disease  chiefly  in  its  own 
lair — change  of  air  and  work  are  rarely  possible — 
and  this  is  a  fight  which  needs  all  the  weapons  that 
modern  science  can  give  us,  all  our  patience  and 
all  our  skill;  but  when  one  weighs  up  the  results 
it  is  a  fight  worth  the  fighting. 

Whatever  the  original  cause  of  the  condition  may 
be,  we  find  that  sooner  or  later,  in  almost  every 
case,  we  have  a  microbic  infection  to  deal  with.   It 


BRONCHITIS  AND  ASTHMA  147 

is  very  rarely  that  one  finds  the  sputum  sterile.  The 
microbes  that  we  find  are  chiefly — and  I  am  trying 
to  give  them  in  the  order  of  their  frequency — the 
Micrococcus  catarrhalis,  pneumococcus,  one  or  other 
variety  of  staphylococcus,  and  streptococcus.  The 
Friedlander  and  proteus  are  more  rarely  found,  but 
in  my  experience  are  very  important.  When  one 
has  attacked  these  poisonous  microbes  with  auto- 
genous vaccines,  and  has  watched  and  weighed  the 
results,  one  must,  I  think,  arrive  at  the  conclusion 
that  they  are  the  chief  factors  that  maintain  and 
perpetuate  the  disease.  I  am  by  no  means  claiming 
that  we  always  get  good  effects  from  this  treatment, 
but  the  number  of  cases  that  are  either  cured  or 
much  relieved  by  this  method  are  so  far  in  excess  of 
the  failures  that  I  must  come  to  this  conclusion. 
In  fact,  I  have  almost  come  to  the  further  conclu- 
sion that  failure  is  the  result  of  some  error  either  in 
the  selection  of  the  microbes  or  in  the  technique  of 
the  preparations.  The  numberless  cases  that  have 
been  cured  by  vaccine  during  the  last  few  years 
should  encourage  us  to  further  scientific  investiga- 
tion, and  the  failures  should  only  serve  to  reveal 
our  defects. 

There  is  one  point  that  I  must  emphasize  in  this 
place — that  is,  the  importance  of  a  good,  careful 


148  ROAD  TO  A  HEALTHY  OLD  AGE 

bacteriologist.  The  preparation  of  these  vaccines, 
if  done  in  a  careless,  unintelligent  way,  will  only 
lead  to  failure  and  disappointment;  and,  what  is 
perhaps  worse,  will  cast  a  stigma  on  us  and  on  that 
subject  of  our  pride,  medical  science. 

I  am  not  speaking  like  this  without  good  reason, 
for  even  in  large,  well-known  bacterial  laboratories 
I  have  known  very  poor  work  done.  I  am  inclined 
to  think  that  private  workers,  and  preferably  med- 
ical men,  will  oftentimes  make  better  vaccines  than 
institutions  where  individual  watching  and  direc- 
tion is  very  difficult.  As  an  example,  we  who  have 
had  any  considerable  experience  of  these  methods 
must  have  come  across  cases  which  have  been  cured 
by  one  man's  vaccine  where  another  man's  has 
totally  failed.  It  is  perhaps  hardly  necessary  to 
say  that  all  vaccines  for  this  disease  should  be  auto- 
genous; and  yet  I  have  known  stock  vaccines  sent 
out  and  recommended  as  equally  good.  We  may 
say  that  this  is  a  case  of  pneumococcus  poisoning 
or  of  streptococcus,  but  we  are  still  in  the  dark  as 
To  how  many  strains  or  varieties  there  may  be  of 
the  same  named  microbe.  In  a  few  cases  of  acute 
pneumonia,  where  there  has  been  no  time  to  make 
an  autogenous  vaccine,  I  have  known  a  stock  vac- 
cine do  wonders,   but  they  are   quite   the  excep- 


BRONCHITIS  AND  ASTHMA  149 

tion;  in  such  cases  a  shot  in  the  dark  is  justifi- 
able. 

Hitherto  I  have  been  looking  at  this  disease  from 
the  point  of  view  only  of  the  invader,  and  I  have 
been  considering  only  the  destruction  of  the  enemy 
by  our  artillery.  The  wise  physician  will  soon  see 
that  this  is  only  part  of  the  problem.  The  patient 
who  has  unluckily  got  the  disease  is  really  the  man 
who  has  to  do  the  fighting;  we  can  help  him  much 
by  attacking  the  enemy  from  without,  but  we  must 
also  teach  him  and  help  him  to  put  his  natural  de- 
fences in  order.  Strictly  speaking,  we  must  look 
on  these  poisonous  bacteria  as  foreigners,  but  as  a 
matter  of  fact  they  are  almost  always  with  us. 
Very  rarely  does  a  microscopical  examination  of  the 
mucus  of  the  nose  or  mouth  fail  to  show  the  pres- 
ence of  one  or  other  of  them,  even  in  health.  Our 
natural  powers  of  resistance,  our  internal  secretions, 
and  our  phagocytes,  are  generally  able  to  deal  with 
them  eflfectually  and  to  ward  off  their  importunities ; 
but  it  is  when  these  powers  fail  or  are  caught  nap- 
ping, when  the  bacteria  multiply  by  millions  and 
there  is  nothing  to  destroy  them,  when  they  pass 
out  of  their  place  and  invade  the  internal  organs, 
that  disease  is  established.  The  prevention  of  this 
failure  of  resisting  power  must  be  our  first  aim. 


150  ROAD  TO  A  HEALTHY  OLD  AGE 

Overwork,  intemperance,  improper  feeding,  ex- 
posure to  damp  and  chill,  all  tend  to  lower  the 
vitality  and  to  expose  us  to  attack.  These  we  must 
fight  as  best  we  can  and  as  circumstances  allow. 
The  enemy  is  always  round  the  corner  waiting  for 
his  chance.  It  is  to  our  frontiers  that  we  must  al- 
ways be  looking. 

Our  most  vulnerable  points  are  probably  the  nose 
and  mouth.  The  nose  in  health  should  act  as  a 
dust  and  germ  filter  so  effectually  that  no  live  germ 
should  gain  entrance  into  our  system,  but  the  muc- 
ous membrane  of  the  nose,  especially  in  impure  at* 
mospheres,  often  becomes  irritated  and  thickened, 
and  proper  nose-breathing  becomes  a  difficult  thing; 
then  mouth-breathing  becomes  more  or  less  a  habit. 
This,  though  a  natural  passage  for  air,  is  not  an  ef- 
fective filter.  One  sees  how  very  liable  children 
with  adenoids  are  to  bronchitis  and  bronchial  as- 
thma. The  nose,  then,  is  the  first  point  to  attend 
to.  The  physicians  and  surgeons  who  have  devoted 
themselves  to  this  branch  of  work  can  often  give  us 
great  help,  by  restoring  a  proper  nasal  passage 
and  by  attention  to  the  tonsils.  There  is  often  a 
congested,  tender  spot  in  one  or  both  nostrils,  which 
seems  to  act  as  a  centre  from  which  proceed  the 
nerve  storms  that  cause  spasmodic  asthma.    Here, 


BRONCHITIS  AND  ASTHMA  151 

also,  hay  fever  seems  to  originate.  This  spot  needs 
great  care  in  treatment,  and  harm  can  easily  be 
done;  but  some  of  our  chief  specialists,  by  their 
skill,  produce  in  these  cases  something  like  a  mira- 
culous revolution.  Our  largest  frontier,  of  course, 
is  the  skin,  and  this  many  working  folk  habitually 
neglect.  Their  work  often  causes  sweating,  and  the 
skin  that  sweats  needs  careful  washing  and  protec- 
tion. They  often  wear  clothes  that  do  not  absorb 
the  moisture,  and  so,  when  work  ceases,  their  skin 
is  in  contact  with  a  damp,  chilly  material.  Much 
may  be  done  by  bathing  and  after-rubbing  with  a 
rough  towel  to  keep  the  circulation  of  the  skin  in  a 
healthy  resisting  state.  Bronchial  folk,  as  a  rule, 
cannot  stand  a  cold  bath,  and  a  hot  bath  often  relaxes 
the  pores  and  leaves  them  liable  to  chill.  The  best 
plan  is  to  thoroughly  wash  and  soap  in  hot  water 
and  then,  standing  up  with  the  feet  still  in  the  hot 
water,  to  have  two  or  three  good  sponges  down  with 
cold,  beginning  at  the  head.  This  produces  a  good 
reaction  of  the  circulation  and  is  a  pleasant  stim- 
ulant. The  clothing  should  be  not  too  light,  nor  so 
heavy  as  to  produce  perspiration  when  not  at  work. 
Light  woollen  materials  are,  I  think,  the  best,  but 
some  of  the  modern  cellular  makes  of  cotton  seem  to 
answer  well. 


152  ROAD  TO  A  HEALTHY  OLD  AGE 

It  is  clear,  then,  that  anyone  with  a  tendency  to 
bronchial  catarrh  or  asthma  needs  to  lead  a  most 
careful  and  watchful  life;  he  is  incessantly  almost 
open  to  attack  from  hostile  germs,  and  every  chill 
weakens  his  defences.  We,  on  our  part,  can  do 
much  to  help  these  cases  by  looking  to  the  heart  and 
bloodvessels,  the  digestion  and  the  kidneys.  Many 
of  these  patients,  especially  in  middle  life,  have 
overstrained,  dilated  hearts,  and  often  some  degree 
of  arterio-sclerosis,  and  there  may  be  early  kidney 
trouble.  The  action  of  the  liver  often  is  sluggish, 
and  the  organ  may  be  congested;  this,  of  course, 
causes  indigestion  and  the  flatulence  which  bothers 
many  of  them  so  much.  Careful  attention  to  all 
these  points  will  help  much  towards  cure,  especially 
in  conjunction  with  the  vaccine  treatment.  To  gain 
real  success  the  old  therapeutics  and  the  new  must 
go  hand  in  hand. 

There  is  a  distinctly  gouty  form  of  chronic  bron- 
chitis which  often  alternates  with  true  gout  and  ec- 
zema. This,  in  the  first  instance,  will  only  yield 
to  appropriate  gouty  treatment — alkalies,  sulphur, 
etc.;  but  even  this  form  becomes  bacterial  in  the 
end,  and  the  sputum  should  always  be  examined. 
Most  of  the  remedies  (and  they  are  almost  innum- 
erable) that  we  have  used  empirically  in  the  past 


BRONCHITIS  AND  ASTHMA  153 

have  acted  chiefly  as  bactericides — for  example,  the 
tars,  turpentine,  terebene,  the  balsams,  the  ben- 
zoates ;  the  great  favorite,  iodide  of  potassium,  acts 
probably  in  this  way,  directly  by  its  iodine  and  in- 
directly by  stimulating  the  output  of  thyroid  secre- 
tion. Chloride  of  ammonium,  again,  probably  acts 
in  the  same  way.  Antimony,  which  in  the  acute 
early  stages  of  bronchitis  was  our  forefathers' 
sheet-anchor,  and  which  has  fallen  out  of  use  far 
too  much,  is  probably  a  bactericide  (vide  its  action 
on  trypanosomes).  While  carrying  out  the  vaccine 
treatment,  even  if  there  be  no  cardiac  complication, 
the  patient  will  need  helping  in  every  possible  way. 
Arsenic  and  iron  are  often  very  useful.  The  judi- 
cious use  of  internal  secretion  preparations  will 
often  help  wonderfully.  In  cases  with  high  tension 
and  threatening  arterio-sclerosis,  thyroid  will  often 
bring  about  a  better  state  of  general  health  and  help 
to  reduce  abnormal  deposits  of  fat  about  the  heart. 
In  others  suprarenal  extract  will  do  good,  especially 
if  arterial  tension  be  low;  in  others  one  of  the  poly- 
glandular preparations  will  raise  the  general  tone 
and  resisting  power. 

When  we  come  to  the  practical  use  of  vaccines, 
we  have  first  to  find  out  what  the  sputum  contains — 
for  there  will  rarely  be  only  one  enemy — and  then 


154  ROAD  TO  A  HEALTHY  OLD  AGE 

to  decide  on  a  single  or  multiple  vaccine.  I  think 
we  must  give  the  pneumococcus  the  place  of  honor. 
He  is  as  common  as  any,  and  perhaps  the  most 
easily  cured.  It  is  very  surprising  how  many  cases 
of  chronic  bronchitis,  with  or  without  asthma,  have 
pneumococci,  even  when  there  is  no  history  of  any 
attack  that  one  can  suspect  of  being  true  pneumonia. 
One  must,  I  think,  come  to  the  conclusion  that  many 
attacks  of  acute  bronchitis  are  pneumococcic  in 
origin,  even  when  there  have  been  no  signs  of  lung 
consolidation  or  of  rusty  sputum.  In  the  British 
Medical  Journal  of  June  14,  19 13,  Dr.  Pirie,  in  an 
article  that  is  very  instructive  both  to  the  physician 
and  to  the  bacteriologist,  gives  the  following  stat- 
istics : 

Bacteriology  of  Sixteen  Cases  of  Chronic  Bronchitis 
without  Asthma. 

Pneumococci    12  cases 

M.  catarrhalis 12     " 

Staphylococci    5     " 

Streptococci    6     " 

Friedlander  5     " 

In  sixteen  cases  of  chronic  bronchial  asthma  he 
found : 

Pneumococci    16  cases 

M.  catarrhalis 16     " 

Staphylococci    8     " 

Streptococci    6     " 

Friedlander  6     " 


BRONCHITIS  AND  ASTHMA  155 

The  almost  universal  absence  or  non-discovery 
of  the  influenza  bacillus,  even  with  a  clear  history 
of  a  recent  attack,  is  remarkable.  The  selection 
will,  to  a  certain  extent,  depend  on  the  predomin- 
ance of  one  or  other  bacillus  in  the  culture,  and, 
generally  speaking,  a  multiple  vaccine,  with  the  pos- 
sible exception  of  the  pneumococcus,  is  more  likely 
to  be  effectual  than  a  single  one.  The  following 
is  the  experience  of  my  son.  Dr.  Arthur  Scott,  of 
Bournemouth,  who  has  for  the  last  three  years 
made  most  of  my  vaccines : 

"  Much  disappointment  and  doubt  as  to  the  value 
of  vaccines  in  chronic  chest  complaints  is,  I  believe, 
prevalent  among  the  medical  profession.  Yet  I 
think  that  those  medical  men  who  have  given  them, 
in  chronic  cases,  frequent  and  prolonged  trial  be- 
come more  and  more  convinced  of  their  general 
value ;  I  say  general  value,  for  one  meets  with  many 
failures  in  cases  which  one  thinks  would  promise 
well.  Granted  a  definite  curative  value  in  vaccines, 
it  becomes  difficult  to  explain  their  complete  failure 
in  certain  cases.  Making  an  attempt  to  group  these 
causes  of  failure,  there  is  in  the  first  place  the  un- 
known condition  in  some  patients  that  negatives 
immunity;  for  example,  from  an  attack  of  measles 
one  person  becomes  immune  for  life,  another  may 


156  ROAD  TO  A  HEALTHY  OLD  AGE 

get  it  again  in  a  few  months.  It  seems  that  there 
is  a  failure  on  the  part  of  some  patients  to  retain 
their  antibodies  in  the  system. 

"  In  a  second  group,  and  it  is  a  large  one,  the 
vaccine  is  at  fault.  In  nearly  all  bronchial  cases 
there  is  a  mixed  infection,  and  the  difficulty  in 
choosing  from  which  bacteria  to  make  the  vaccine 
arises.  Make  a  separate  vaccine  of  all  the  likely 
bacteria  present  and  mix  them  together  is  the  ap- 
parent solution  of  the  problem,  but  this  entails  mak- 
ing subcultures  into  several  generations,  and  vac- 
cines from  subcultures  have  very  little  power  of 
conferring  immunity.  Probably  the  most  efficient 
way  is  to  make  a  solution  from  the  primary  culture, 
then  estimate  the  relative  proportions  of  the  varie- 
ties of  bacteria  to  each  other,  by  naked-eye  examina- 
tion of  the  cultures  (this  is  rather  guess-work),  or 
where  possible  by  examining  a  prepared  slide  of  the 
solution.  The  predominating  variety  is  then  not 
subcultured,  but  the  varieties  occurring  in  smaller 
numbers  are  subcultured  and  added  to  the  original 
solution  in  proportion  to  the  dose  required  for  ad- 
ministration. This  method  is  necessarily  faulty,  but 
not  more  so  than  the  use  of  impure  subcultures  of 
all  the  varieties.  Subcultures  can  only  be  obtained 
pure  after  several  generations  have  been  made. 


BRONCHITIS  AND  ASTHMA  157 

"  Often  the  method  of  sterilization  of  the  vac- 
cine destroys  its  value;  for  example,  a  pneumococ- 
cal vaccine  begins  to  lose  its  virtue  when  heated  to 
55°  C,  whereas  a  staphylococcal  vaccine  may  not 
be  killed  at  60°  C.  This  explanation  shows  that  it 
is  not  necessarily  the  principle  of  vaccination  that 
is  the  cause  of  failure,  but  often  the  so  far  insuper- 
able difficulties  of  the  bacteriologist.  It  is  possible 
that  in  the  future  the  X  rays  may  help  to  solve  some 
of  these  difficulties. 

"In  a  third  group  error  in  administration  is  the 
cause  of  failure.  The  size  of  the  doses  and  the  in- 
tervals between  them  can  only  be  determined  by  the 
patient's  symptoms.  The  opsonic  index  will  not 
help,  as  in  bronchial  cases  it  is  a  question  of  local 
or  tissue  immunity  rather  than  of  general  immunity. 
Of  more  importance  than  all  is  the  duration  of  the 
treatment.  Most  patients  are  not  kept  under  treat- 
ment nearly  long  enough.  It  is  to  be  remembered 
that  the  bacteria  present  are  probably  leading  a 
saprophytic  as  well  as  a  parasitic  existence.  This  I 
personally  believe  to  be  always  the  case  in  chronic 
bronchitis.  Thus  the  organisms  present  are  living 
not  only  on  the  bronchial  epithelium,  but  also  on 
the  bronchial  secretions;  these  are,  in  the  first 
place,    set    up   by    repeated    bacterial    attacks    on 


158   ROAD  TO  A  HEALTHY  OLD  AGE 

the  epithelial  cells,  which  are  then  kept  actively- 
secreting  by  the  irritation  of  the  toxins,  a  vicious 
circle  being  thus  formed.  Hence,  if  both  general 
and  local  immunity  are  obtained,  it  will  not  follow 
that  the  symptoms  of  bronchitis  will  at  once  disap- 
pear; for  the  saprophytic  existence  of  the  bacteria 
is  not  only  active,  but  is  waiting  for  lowering  of  im- 
munity to  attack  again.  For  these  reasons  I  think 
that  vaccine  treatment  of  chronic  chest  catarrhs, 
etc.,  should  be  continued  for  very  much  longer 
periods  of  time  than  is  now  usually  done,  so  as  to 
allow  the  bronchial  epithelium  to  regain  a  normal, 
healthy  condition.  I  believe  that  in  old-standing 
cases  of  bronchial  asthma  treatment  of  less  than 
two  years'  duration  is  of  little  use.  The  vaccines 
will  not  need  to  be  given  very  frequently  after  the 
first  six  months;  once  a  fortnight,  or  once  in  three 
weeks,  is  generally  sufficient." 

From  my  own  experience  I  would  further  say 
that  in  these  long-standing  cases  it  is  good  policy 
to  have  a  fresh  bacterial  examination  made  every 
six  months  or  so,  and  if  the  bacterial  conditions 
have  altered,  to  have  a  fresh  vaccine  made.  One  of 
the  most  successful  cases  I  have  ever  seen  is  an  old 
lady,  now  seventy-nine  years  of  age,  who  lived  out 
of  England  for  many  years  in  the  hope  of  getting 


BRONCHITIS  AND  ASTHMA  159 

rid  of  persistent  bronchial  asthma.  She  finally  came 
to  Bournemouth  to  end  her  days  as  a  hopeless  case. 
She  has  been  under  treatment  now  for  four  years, 
having  a  vaccine,  which  is  changed  from  time  to 
time,  every  fortnight.  Under  this  she  has  regained  a 
very  fair  degree  of  health,  and  the  bronchial  asthma 
is  almost  cured.  Age  is  no  bar  to  this  treatment. 
Quite  old  people  of  seventy-five  to  eighty-five  do 
very  well  and  get  no  alarming  symptoms.  Children 
also  of  two  or  three  years  old  respond  equally  well. 
The  most  disappointing  cases,  perhaps,  are  in  over- 
worked, anxious,  neurotic,  middle-aged  folk.  Con- 
firmed emphysema  has,  by  some,  been  thought  to 
be  unsuitable  for  vaccines,  but  that  is  not  at  all  my 
experience.  On  the  contrary,  I  have  seen  bad  cases 
of  emphysema  very  much  improved,  and  surely  it 
is  only  what  one  would  expect;  if  catarrh,  cough, 
and  expectoration  are  lessened  or  cured,  the  lung 
substance  has  again  a  chance  to  recover  its  elasti- 
city. As  I  have  said  before,  pneumococcic  cases 
often  respond  quickly  and  well.  Catarrhalis  cases 
vary,  but  are  generally  rather  obstinate,  and  it  is 
not  always  easy  to  find  the  suitable  dose  to  begin 
with.  Too  big  a  dose  will  sometimes  increase  dys- 
pnoea. Staphylococcus  cases  are  generally  in  con- 
junction  with   pneumococci   or   more   often   with 


i6o  ROAD  TO  A  HEALTHY  OLD  AGE 

catarrhalis,  and  a  double  vaccine  often  answers  welL 
Streptococci  cases  will  often  need  a  long  course, 
but  do  very  well  in  the  end.  There  are  two  other 
microbes  which  are  more  rarely  found — genus  tetra- 
genus  and  proteus.  These  make  excellent  vaccines, 
and  the  addition  of  one  or  other  of  them  will  often 
cause  a  pneumo  or  strepto  vaccine  to  succeed  per- 
fectly, when  before  there  was  failure.  In  plastic 
bronchitis  the  proteus  may  be  found  buried  in  the 
casts  only,  and  not  in  the  general  mass.  This  mi- 
crobe will  not  seldom  be  found  with  pneumococci. 
It  is  well  to  begin  with  a  small  dose,  ten  or  fifteen 
millions,  and  to  watch  for  symptoms  of  irritation 
such  as  increased  cough  or  dyspnoea ;  a  rise  of  tem- 
perature is  very  rare,  and  if  it  occur  should  cause 
no  alarm.  The  smaller  doses  should  be  given  every 
four  or  five  days.  When  one  has  found  the  dose 
that  does  good,  it  is  better,  I  think,  to  stick  to  it, 
and  to  give  it  every  ten  days  or  so  till  one  has  got 
the  symptoms  well  under  control,  and  then  to  carry 
it  on  at  intervals  of  every  two  or  three  weeks  for 
a  year  or  more. 

Many  physicians  in  our  large  manufacturing 
towns,  where  there  is  always  a  more  or  less  con- 
taminated, irritating  atmosphere,  have  had  poor  re- 
sults with  this  treatment,  and  have  consequently 


BRONCHITIS  AND  ASTHMA  i6i 

abandoned  it.  This  is  not  very  surprising,  but  I 
have  found  the  cases  of  failure  do  very  well  if  the 
treatment  is  carried  out  in  a  pure  air.  The  con- 
stant irritation  of  the  inhaled  air  or,  it  may  be,  con- 
tinual reinfection,  is  enough  to  turn  the  balance 
against  the  vaccine.  This  is  a  case  in  point :  A  man 
of  sixty-five  was  living  in  Manchester.  He  came 
to  Bournemouth  four  years  ago  in  very  bad  plight 
— chronic  bronchitis,  asthma,  dilated  heart,  emphy- 
sema, and  high  blood-pressure.  He  was  unable  to 
lie  down  and  got  but  little  sleep.  The  vaccine  treat- 
ment had  been  forbidden  in  Manchester,  by  one  of 
its  chief  physicians,  because  he  had  such  marked  em- 
physema and  high  blood-pressure;  the  logical  pro- 
cess involved  in  this  opinion  remains  a  mystery. 
He  wisely  consented  to  a  trial.  The  sputum  con- 
tained pneumococcus  and  catarrhalis.  In  three 
weeks  he  was  much  better  and  was  able  to  lie  down 
at  night,  and  what  this  means  none  but  the  suffer- 
ers know.  In  two  months  he  was  able  to  go  back 
to  Manchester.  Living  in  such  a  climate,  he  has 
of  his  own  accord  had  a  fresh  vaccine  made  each 
year,  and  has  a  dose  about  once  a  month  or  rather 
oftener  in  winter.  He  has  been  all  this  time  prac- 
tically well.  He  has  a  little  phlegm  and  is  rather 
short  of  breath,  but  is  able  to  enjoy  his  life  quietly. 


i62   ROAD  TO  A  HEALTHY  OLD  AGE 

The  heart  is  no  longer  dilated  and  his  blood-pres- 
sure has  come  down  to  the  normal  without  any 
medicinal  help.  During  these  four  years  he  has  had 
no  medicines  for  his  bronchial  trouble.  I  believe 
this  to  be  a  typical  case,  and  if  physicians  working 
in  our  manufacturing  towns  would  try  this  treat- 
ment, and  have  it  carried  out  in  a  pure  air,  their 
results,  in  my  opinion,  would  be  as  good.  A  pure 
air  is  of  more  importance  than  a  warm  air. 

The  following  case,  which  I  have  watched  for 
ten  years,  is  very  instructive :  A  lady,  seventy-eight 
years  of  age,  had  had  bronchial  asthma  for  many 
years,  resulting  in  much  emphysema;  when  she 
came  under  my  care  the  bronchitis  and  asthma  were 
so  severe  and  so  incessant  that  she  had  not  been 
able  to  lie  down  for  seven  years — in  fact,  she  had 
no  bed  in  her  room.  The  feet  and  legs  were  oede- 
matous,  and  her  life  was  a  misery.  I  found  her 
sputum  contained  catarrhalis  and  Friedlander. 
Under  a  vaccine  she  slowly  began  to  improve.  The 
vaccine  was  changed  from  time  to  time,  and  in  two 
years  she  was  almost  without  cough  and  quite  with- 
out asthma.  The  heart  and  arteries  were  much  af- 
fected by  the  years  of  strain;  the  heart  was  dilated, 
blood-pressure  was  often  very  high,  and  there  was 
still  at  times  a  tendency  to  oedema  of  the  feet  and 


BRONCHITIS  AND  ASTHMA  163 

legs,  and  shortness  of  breath  on  exertion.  She  suf- 
fered much  from  vertigo  and  tinnitus.  Under  hip- 
purates  and  strophanthus  the  conditions  gradually 
improved,  but  she  had  two  very  severe  attacks  of 
nose-bleeding.  About  four  years  after  the  treat- 
ment began  her  blood-pressure  was  generally  nor- 
mal, and  she  lost  her  vertigo,  but  her  heart  was  still 
feeble.  She  went  on  in  much  the  same  condition 
till  the  summer  of  191 5,  when  she  got  a  very  bad 
attack  of  laryngitis,  with  some  bronchitis  but  no 
asthma.  She,  rather  to  my  surprise,  pulled  through 
this  ordeal,  but  her  heart  was  very  weak  and  dilated. 
In  spite  of  her  former  high  blood-pressure,  I  gave 
her  suprarenal  extract,  a  5-grain  tablet  of  the  fresh 
gland  three  times  a  day.  This  acted  wonderfully 
as  a  circulation  tonic,  and  has  never  raised  the  pres- 
sure above  140  mm.  She  does  not  know  what  she 
^is  taking,  but  both  she  and  her  maid  have  come 
to  the  conclusion,  after  two  or  three  trials,  that  she 
is  never  well  without  them,  and  she  has  taken  three 
tablets  a  day  almost  without  intermission  for 
eighteen  months.  I  look  on  this  case  as  a  triumph 
for  modern  therapeutics. 

It  is  hardly  necessary  for  me  to  say  that  all  vac- 
cine treatment  should  be  carried  through  with  strict 
antiseptic  precautions.     I  find   that  washing  the 


i64  ROAD  TO  A  HEALTHY  OLD  AGE 

syringe  and  needle  inside  and  out  with  a  weak  lysol 
solution  is  a  quick  and  safe  plan;  the  patient's  skin 
should  be  cleaned  with  the  same  solution  or  with 
iodine.  If  lysol  is  left  in  the  syringe,  more  pain 
is  caused  than  is  necessary;  so  I  wash  it  out,  be- 
fore drawing  in  the  vaccine,  with  boiled  water.  The 
collection  of  sputum  should  be  done  in  the  morning, 
if  possible,  before  food  is  taken,  and  the  mouth 
should  be  washed  out  previously  with  hot  water, 
not  with  any  antiseptic  wash.  The  sputum  should 
be  expectorated  straight  into  a  wide-mouthed  bottle 
with  glass  stopper  that  has  been  sterilized  by  boil- 
ing the  previous  night,  and  should  be  sent  with  little 
delay  to  the  examiner. 

In  many  of  these  cases  one  will  find  high  tension 
and  early  symptoms  of  arterio-sclerosis ;  this  has 
been  thought  by  some  to  contraindicate  vaccine,  but 
my  experience  has,  with  these  cases,  been  very 
favorable.  The  high  tension,  etc.,  has  been  to  a 
large  extent  brought  about  by  the  continual  strain 
of  coughing  and  dyspnoea  and  by  broken  rest,  and 
the  relief  of  these  will  alone  lower  tension.  It  is 
very  common  for  old  people  who  have  had  a  chronic 
cough  to  die  of  a  sudden  unexplainable  pneumonia, 
without  any  chill  or  exposure  to  infection;  these 
cases  are  all  latent  pneumococcic  affections.    For 


BRONCHITIS  AND  ASTHMA  165 

some  reason  the  resisting  power  has  given  way,  and 
the  invasion  has  taken  place.  Such  cases  could  prob- 
ably be  easily  prevented  by  the  occasional  use  of 
pneumococcus  vaccines,  for  the  microbe  could  have 
been  detected  in  the  sputum  of  the  chronic  state. 

Further,  arterio-sclerosis  is  thought  by  many  to 
be  caused  in  some  cases  by  auto-intoxication  from 
the  abnormal  bacteria  of  the  digestive  tract;  is  it 
not  reasonable  to  think  that  it  may  be  caused  also 
by  auto-intoxication  from  the  abnormal  bacteria  of 
the  respiratory  tract?  Whatever  the  cause  may  be, 
you  will  generally  have  the  satisfaction  of  seeing 
the  high  tension  satisfactorily  subside,  with  all  its 
accompanying  symptoms,  and  this  will  take  place 
without  using  any  depressor  remedies. 

With  such  a  varied  pathological  cause  for  the 
group  of  morbid  symptoms  that  we  call  bronchial 
asthma,  is  it  reasonable  to  expect  that  any  medicinal 
course  of  treatment,  either  by  the  stomach  or  by 
inhalation,  can  ever  effect  a  radical  cure,  or  have 
any  but  a  passing  action?  A  symptom  here  and 
there  can  be  relieved  and  the  patient  made  more 
comfortable  {vide  the  endless  list  of  patent  and 
proprietary  cures  that  are  no  cures).  As  scientific 
men  we  should  go,  if  possible,  to  the  roots  of  the 
disease,  and  the  modern  science  of  bacteriology  is 


i66  ROAD  TO  A  HEALTHY  OLD  AGE 

helping  us  to  do  this  most  effectually.  We  have 
much  to  learn,  and  something  to  unlearn,  but  pa- 
tience and  honest  work  wift  produce  undreamt-of 
results.  Finally,  I  look  on  this  treatment  as  a  true 
and  logical  extension  of  my  dream — organic  or  en- 
dogenous therapeutics. 


INDEX 


Addison's  disease,  130 

Adrenine,  129-130 

Alcohol,  8s,  102,  103-104 

Allbutt,  Sir  Clifford,  90,  100, 
124 

Altruism,  31 

Anger,  16 

Animals,  duration  of  life,  66 

Antiseptics,  163-164 

Arterial  tension,  82 

Arterio-sclerosis,  13,  79,  80, 
82,  89-90,  194;  criticism  of 
treatment,  142-144;  descrip- 
tion, 83;  three  classes  and 
their  treatment,  138-142 

Asthma,  rational  cure  of 
bronchial,  145-166 

Atheroma,  115,  128,  140,  141 

Atmosphere  of  cities,  145, 
160-161 

Atwater's  standard,  56 

Austen,  Jane,  22 

Autogenous  vaccines,  147 

Auto-intoxication,  165 

Bacon,  51 

Bacon,  Sir  Francis,  Z7 

Bacteria,    intestinal,    98,    99; 

mouth  and  nose,  149 
Bactericides,  153 
Bacteriology,  148,  154,  165 
Balfour,  Arthur,  29 
Balneology,  137-138 
Barclay,  Captain,  87 
Barr,  Sir  James,  136 
Bath,  151 
Beliefs,  30 

Bergonie  Faradic  method,  138 
Biedl,  70,  93,  112,  116,  119 
gladder  weakness,  121 


167 


Bleeding,  135-136 
Blood  conditions,  134 
Blood  pressure,  82,  91,  100 
Bluff,  professional,  vii 
Brain  workers,  90 
Breath,  shortness,  95-96 
Bright's  disease,  85 
Bronchitis,    rational   cure   of 

chronic,  145-166 
Brown-Sequard,  70,  131 
Brunton,  Sir  Lauder,  16,  82, 

87,  90,  99.  103,  104,  123 

Calcium  salts,  119 

Calories,  52-53 

Calvin,  42 

Campbell,  Dr.  Harry,  51 

Cancer,  12,  79 

Carbohydrates,  Si,  52,  5S-S6 

Carnrich   and   Co.,    127,    132, 

133 
Cato,  39 

Cause  and  effect,  11-12 
Cereals,  51 
Christianity,  28,  42 
Christ's  Second  Coming,  2,  3 
Church,  3,  4 
Churchill,  Winston,  28 
Cicero,  10,  18,  21,  39,  108 
Clark,  Sir  Andrew,  47 
Clothing,  151 
Coffee,  102 
Condiments,  48 
Creeds,  29 
Cretinism,  115,  130 

Dante,  42 
Death,  43,  75,  79 
Decay,  senile,  62-6^ 


i68 


INDEX 


Diet,  ideal,  51 ;  mixed,  50; 
presclerotic  stage,  100 ;  pro- 
portions, 56;  see  also  Food 

Digestion,  44,  46;  errors  and 
haste,  98 

Digitalis,  123-126 

Diseases,  75,  81 

Drinking,  134 

Drugs,  78 

Egoism  and  egotism,  30 
Eiselberg,  115 
Electricity,  138 
Emphysema,  159,  162 
Eppinger,  116 
Evolution,  75-76 
Exercise,  108,  135 

Fats,  SI,  54,  59,  60 

Fish,  50 

Food,  foods,  chewing,  47;  di- 
gestion, 44,  46;  digestibility, 
60-61 ;  purin  contents,  loo- 
loi ;  quantity,  45 ;  regula- 
tion, 19;  value,  table,  58; 
value  and  digestibility,  44- 
61 ;  variety,  48 

Forms,  29 

Fothergill,  Milner,  62,  72 

Freedom,  31 

Froude,  65 

Fruit,  137 

Future  life,  42 

Germany,  5,  8 

Glands,  ductless,  18,  70,  71,  77, 

hi;  extracts,  129-134 
God,  6,  42 
Golf,  108 
Gout,  85,  103,  152 
Grundy,  Mrs.,  24,  26 

Habits,  20 

Hall,  Dr.  de  Havilland,  79 

Hardwick,  S.,  133 

Hay  fever,  151 

Health,  prolongation,  62-76 


Heart,  13,  16,  59,  81-82,  84; 
dilatation,  122;  stimulating, 
86-87;  strain,  88;  tonics, 
126,  127 

Herd  law,  25 

Hermotones,  127,  132,  133 

Hippurate  salts,  no 

Horace,  17 

Horsley,  Sir  Victor,  120 

Humanity,  2,  6 

Hurry,  16 

Hutchinson,  Dr.,  60 

Hydropathic  treatment,  138 

Hypertrophy,  92-93 

Individualism,  9,  23,  28,  30 
Influenza  bacillus,  155 
Intestines,  poisoning,  97 
Iodide  of  potassium,  109,  114 
Iodides,  115 

Job,  64-65 

Know  thyself,  i,  14-iS 

Laws,  physiological,  11 

Lecithin,  113 

Life,  duration,  average,  65-68, 
78-79;  prime,  62;  prolonga- 
tion, 1-43;  value,  1-9 

Listerism,   77 

Llangammarch  Wells,  138 

Mackenzie,  123 

Maladies,  75 

Manchester,  161 

Marabotto,  Dr.,  128 

Mastication,  46-47 

Meat,  20,  50 

Mediocrity,  24 

Metchnikoff,  70 

Microbes,  poisonous,  145,  147 

Milk,  57,  137 

Mind,    activity,    35;    atrophy, 

32-33 
Monotony  in  food,  48-49 
Mortality,  79 
Mount  Vernon  Hospital,  123 


INDEX 


169 


Mouth,  149,  150 
Murray,  Dr.  George,  129 
Myxcedema,  118,  115,  120 

Nauheim  treatment,   137,   138 
Nitrites,  109 
Normality,  68 
Nose,  149,  150 

Old   age,   Cicero   quoted,   21, 

39;    picture    of    premature, 

71-72;  regularity  of  life,  19 

Oliver,  Dr.  George,  90,  91,  94, 

99,  no 
Organic  remedies,  TJ^  no,  166 
Orthodoxy,  24,  28 
Ovary  extract,  127,  131 
Over-exertion,  15,  16,  107 

Penalties,  11 
Penn,  William,  28 
Phosphorus,  112,  113 
Pirie,  Dr.,  154 
Pitglandin,  131,  132,  144 
Pituitary  extract,  127 
Pneumococcus,  147,  148,  154, 

160 
Pneumonia,  154,  164 
Poisoning,  intestinal,  97 
Presclerosis,  95,  100 
Price,  Dr.  F.  W.,  123 
Pride,  22,  36 

Progress,  5,  25,  29,  75,  '/^ 
Prolongation  of  health,  62-76 
Prolongation  of  life,  1-43 
Prostate  gland,  121 
Protein,  53-54 
Public  opinion,  27 

Retirement,  32,  34 
Rhubarb,  137 

St.  George's  Hospital,  56,  126 

St.  Paul,  16-17 

Saliva,  47 

Science,  5 

Sclerosis.     See   Arterio-scle- 

rosis 
Scott,  Dr.  Arthur,  155 


Sedentary  occupations,  90,  91, 
107,  135 

Self-indulgence,  65 

Selfishness,  36 

Senile  decay,  62-63 

Senility,  68,  71 ;  treatment 
and  prevention  of  prema- 
ture, 77-144 

Short,  Rendle,  115,  119 

Skin,  151 

Sleep,  135 

Smoking,  104-107 

Socialism,  28 

Solomon,  8 

Spartein  sulphate,  122 

Spriggs,  Dr.,  53,  56,  57 

Starchy  foods.  See  Carbohy- 
drates 

Stevenson,  R.  L.,  32,  37,  40, 
80 

Stimulants,  85 

Stomach,  specialists,  lo-ii 

Strain,  16,  90 

Streptococcus,  147,  148,  160 

Strophanthus,  122 

Success,  22 

Sugar,  59,  102 

Superstition,  8 

Suprarenal  extract,  112,  114, 
116,  128,  129,  133,  153,  163 

Sutherland,  Dr.  G.  A.,  53 

Tea,  102 

Teeth,  46 

Temperature,  15 

Testis  extract,  127,  131 

Thorne,  Dr.,  138 

Thymus    gland   extract,    133- 

134 
Thyroid  gland,  117-121 
Thyroid    treatment,    111-115, 

121,    131,    153;    conclusions 

of  Biedl  and  Eppinger,  116- 

117 
Tobacco,  104-107 
Tonsils,  150 

Unbelief,  29 
Uniformity,  25 


170 


INDEX 


Vaccine  treatment,  147, 153, 155 
Vegetables,  50 
Vegetarianism,  66 
Vision,  8 

Walking,  107 
War,  5,  8 
Wearing  out,  1% 


Weber,  Sir  Hermann,  v 
Whitla,  Sir  William,  124 
Whittier,  J.  G.,  41,  43 
Wme,  103 
Wisdom,  32 
Women,  23 

Youth,  37 


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